MEDICARE: ANGELA M COOPER RD

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	133V00000X	Registered Dietitian		MI

General Provider Information

NPI Number	:	1164801635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA M COOPER RD

Provider Business Mailing Address
First Line	:	5154 SUNSET DR
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-5647
Country	:	US
Telephone Number	:	517-474-6149
Fax Number	:

Provider Business Practice Location Address
First Line	:	5154 SUNSET DR
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-5647
Country	:	US
Telephone Number	:	517-474-6149
Fax Number	:

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

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	03/06/2026

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