Provider Demographics
NPI:1003426248
Name:COOPER, SANTINO D
Entity Type:Individual
Prefix:MR
First Name:SANTINO
Middle Name:D
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5191 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-1011
Mailing Address - Country:US
Mailing Address - Phone:810-569-0266
Mailing Address - Fax:
Practice Address - Street 1:8255 KENSINGTON BLVD APT 352
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-2963
Practice Address - Country:US
Practice Address - Phone:810-814-4963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker