Healthcare Provider Details

I. General information

NPI: 1568450856
Provider Name (Legal Business Name): MICHAEL J COONEY MD MARK D RICAURTE MD AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 W TOWN ST
COLUMBUS OH
43222-1510
US

IV. Provider business mailing address

719 W TOWN ST
COLUMBUS OH
43222-1510
US

V. Phone/Fax

Practice location:
  • Phone: 614-228-3036
  • Fax: 614-228-5040
Mailing address:
  • Phone: 614-228-3036
  • Fax: 614-228-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL JOHN COONEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 614-228-3036