MEDICARE: DR. SHEILA COOPER MD

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	207L00000X	Anesthesiology Physician	G68831	CA
2	207L00000X	Anesthesiology Physician	8311	NV
3	207L00000X	Anesthesiology Physician	036162159	IL
4	207L00000X	Anesthesiology Physician	11875	HI
5	207L00000X	Anesthesiology Physician	102085-875	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	BG302	OTHER	NV	MEDICARE PTAN
3	P00070482	OTHER	HI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000236455	OTHER	HI	HMSA PROVIDER NUMBER
4	MD11875	OTHER	HI	STATE LICENCE

General Provider Information

NPI Number	:	1578564217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEILA COOPER MD

Provider Business Mailing Address
First Line	:	3157 N RAINBOW BLVD
Second Line	:	#518
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4578
Country	:	US
Telephone Number	:	702-386-4700
Fax Number	:	702-386-4701

Provider Business Practice Location Address
First Line	:	2850 S MOJAVE RD LOT A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-1355
Country	:	US
Telephone Number	:	702-386-4700
Fax Number	:	702-386-4701

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	12/12/2024

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Directions to “ DR. SHEILA COOPER MD” Practice Location

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