Provider Demographics
NPI:1447208475
Name:COOPER, KEVIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7580 NORTHCLIFF AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3270
Mailing Address - Country:US
Mailing Address - Phone:216-472-2741
Mailing Address - Fax:216-472-2740
Practice Address - Street 1:2351 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-861-6200
Practice Address - Fax:216-363-2757
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35057833207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341091834009OtherTRICARE
OHP00402409OtherRAILROAD MEDICARE
OH2765635OtherUNITED HEALTHCARE
OH000000485841OtherANTHEM BCBS
OH5429209OtherAETNA
OH341091834050OtherMEDICAL MUTUAL
OH0893458Medicaid
OHCO0874063Medicare PIN
OHP00402409OtherRAILROAD MEDICARE
OH000000485841OtherANTHEM BCBS