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NPI Code Detail

MEDICARE: DAVID L. COOLEY D.O. P.C.

MEDICARE: DAVID L. COOLEY D.O. P.C.
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
1207Q00000XFamily Medicine PhysicianDC006823MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1120001978OTHERMIRAILROAD MEDICARE TRAVELERS

General Provider Information

NPI Number : 1558445015
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID L. COOLEY D.O. P.C.
Provider Business Mailing Address
First Line : 3902 MONROE ST
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48125-2545
Country : US
Telephone Number : 313-562-1985
Fax Number : 313-562-0380
Provider Business Practice Location Address
First Line : 3902 MONROE ST
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48125-2545
Country : US
Telephone Number : 313-562-1985
Fax Number : 313-562-0380
Authorized Official
Title or Position : OWNER / PHYSICIAN
Name : DR. DAVID L. COOLEY
Credential : D.O.
Telephone Number : 313-562-1985
Provider Enumeration Date : 10/24/2006
Last Update Date : 11/03/2014

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