MEDICARE: M D COOPER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35048099C	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003130683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M D COOPER INC.

Provider Business Mailing Address
First Line	:	2819 HAYES AVE
Second Line	:	STE. 6
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5391
Country	:	US
Telephone Number	:	419-626-0225
Fax Number	:	419-626-0755

Provider Business Practice Location Address
First Line	:	2819 HAYES AVE
Second Line	:	STE. 6
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5391
Country	:	US
Telephone Number	:	419-626-0225
Fax Number	:	419-626-0755

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARSHA D COOPER
Credential	:
Telephone Number	:	419-626-0225

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	03/25/2010

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