Provider Demographics
NPI:1164875738
Name:COOL, MICHAEL R (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:COOL
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:740 W PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3282
Mailing Address - Country:US
Mailing Address - Phone:386-734-9122
Mailing Address - Fax:386-736-4348
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 430
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4424
Practice Address - Country:US
Practice Address - Phone:770-321-1001
Practice Address - Fax:770-321-8290
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2020-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9109654363A00000X
GA9624363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant