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General NPI Number Information
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NPI Number | 1154098259
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Entity Type | Individual
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Provider Name | ALEXANDRA MARIE COOPER PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 707 LAKE COOK RD STE 280
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City | DEERFIELD
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State | IL
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Zip | 60015-5255
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Country | US
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Telephone | 847-480-0004
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Fax | 847-480-8707
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Provider Business Mailing Address
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Address Line | 163 WILLIAM ST
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City | NEW YORK
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State | NY
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Zip | 10038-2602
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 027351
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085010626
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License Number State | IL
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