Healthcare Provider Details

I. General information

NPI: 1982636130
Provider Name (Legal Business Name): JAN N NEAL-COOLS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W US HIGHWAY 2
WAKEFIELD MI
49968-9515
US

IV. Provider business mailing address

103 W US HIGHWAY 2
WAKEFIELD MI
49968-9515
US

V. Phone/Fax

Practice location:
  • Phone: 906-229-6120
  • Fax:
Mailing address:
  • Phone: 906-229-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301055159
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: