MEDICARE: MARIA J COOPER NP

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	363L00000X	Nurse Practitioner	4704163416	MI

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	:	1588642177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA J COOPER NP

Provider Business Mailing Address
First Line	:	38935 ANN ARBOR RD
Second Line	:	CREDENTIALING/PAYER CONTRACTING
City	:	LIVONIA
State	:	MI
Zip	:	48150-3397
Country	:	US
Telephone Number	:	734-632-0175
Fax Number	:	734-632-0182

Provider Business Practice Location Address
First Line	:	33155 ANNAPOLIS ST
Second Line	:	EMERGENCY MEDICINE DEPARTMENT
City	:	WAYNE
State	:	MI
Zip	:	48184-2405
Country	:	US
Telephone Number	:	734-467-4042
Fax Number	:	734-467-5500

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/20/2010

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Directions to “ MARIA J COOPER NP” Practice Location

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