Provider Demographics
NPI:1447220876
Name:COONEY, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:COONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 W TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1510
Mailing Address - Country:US
Mailing Address - Phone:614-228-3036
Mailing Address - Fax:614-228-5040
Practice Address - Street 1:719 W TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1510
Practice Address - Country:US
Practice Address - Phone:614-228-3036
Practice Address - Fax:614-228-5040
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-032524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0226213Medicaid
OHA73845Medicare UPIN
OHCO0371044Medicare ID - Type Unspecified