Provider Demographics
NPI:1386640860
Name:COOPER, RUTH ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RUTH ANN
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415-B AICHOLTZ RD
Mailing Address - Street 2:STE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-5139
Mailing Address - Country:US
Mailing Address - Phone:513-943-0400
Mailing Address - Fax:513-943-6115
Practice Address - Street 1:4415B AICHOLTZ RD
Practice Address - Street 2:STE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-5135
Practice Address - Country:US
Practice Address - Phone:513-943-0400
Practice Address - Fax:513-943-6115
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002540C213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0775791Medicaid
U25552Medicare UPIN
OH0775791Medicaid