Provider Demographics
NPI:1164434155
Name:COOLEY, DENNIS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
Last Name:COOLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2806
Mailing Address - Country:US
Mailing Address - Phone:785-235-0335
Mailing Address - Fax:785-235-0368
Practice Address - Street 1:3500 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2806
Practice Address - Country:US
Practice Address - Phone:785-235-0335
Practice Address - Fax:785-235-0368
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18366208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100194470AMedicaid
KS619160OtherFIRSTGUARD
KS002134OtherBLUE CROSS BLUE SHIELD
KSE54192Medicare UPIN