Healthcare Provider Details

I. General information

NPI: 1073201760
Provider Name (Legal Business Name): COOPER MICHAEL SCOLES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 20TH ST # 205
HUNTINGTON WV
25703-2071
US

IV. Provider business mailing address

1115 20TH ST # 205
HUNTINGTON WV
25703-2071
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1500
  • Fax: 304-523-4358
Mailing address:
  • Phone: 304-691-1500
  • Fax: 304-523-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: