MEDICARE: CARRANDA KOOP M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	4301105400	MI

General Provider Information

NPI Number	:	1023437456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRANDA KOOP M.D.

Provider Business Mailing Address
First Line	:	24 FRANK LLOYD WRIGHT DR LBBY J2000
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9484
Country	:	US
Telephone Number	:	734-747-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	3477 E GRAND RIVER AVE
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48843-8552
Country	:	US
Telephone Number	:	517-234-6540
Fax Number	:	517-338-9083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	07/28/2025

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