Provider Demographics
NPI:1437134764
Name:COOPER, MICHAEL A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:COOPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:922 CHARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5009
Mailing Address - Country:US
Mailing Address - Phone:859-273-5579
Mailing Address - Fax:859-257-8860
Practice Address - Street 1:CHANDLER MEDICAL CTR DIVISION OF GASTROENTEROLOGY
Practice Address - Street 2:800 ROSE STREET, ROOM MN 649
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-5021
Practice Address - Fax:859-257-8860
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYPA145363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical