Provider Demographics
NPI:1033169842
Name:KOOP, MICHAEL RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RICHARD
Last Name:KOOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7710 BEECHNUT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3100
Mailing Address - Country:US
Mailing Address - Phone:713-777-7145
Mailing Address - Fax:713-337-4803
Practice Address - Street 1:7710 BEECHNUT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-3100
Practice Address - Country:US
Practice Address - Phone:713-777-7145
Practice Address - Fax:713-337-4803
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL0350207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119157903Medicaid
TXH22272Medicare UPIN
TX8856K0Medicare PIN