Provider Demographics
NPI:1083471544
Name:COOPER, RYAN (CCAR)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:CCAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 EMMET ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2910
Mailing Address - Country:US
Mailing Address - Phone:231-347-5511
Mailing Address - Fax:
Practice Address - Street 1:2236 E MITCHELL RD STE 5
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9604
Practice Address - Country:US
Practice Address - Phone:313-475-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist