Provider Demographics
NPI:1407080286
Name:COOLEY, THERESA JOANN (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:JOANN
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:JOANN
Other - Last Name:BIESIADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17717 MASONIC BLVD
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026
Mailing Address - Country:US
Mailing Address - Phone:586-294-0600
Mailing Address - Fax:586-294-2525
Practice Address - Street 1:401 SOUTH BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-342-2401
Practice Address - Fax:810-342-2271
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301 094 027207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine