Provider Demographics
NPI:1497723522
Name:COOPER, JONATHAN S (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:COOPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3955 PATIENT CARE DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4299
Mailing Address - Country:US
Mailing Address - Phone:517-374-7600
Mailing Address - Fax:517-374-9042
Practice Address - Street 1:806 HOGSBACK RD
Practice Address - Street 2:SUITE C
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854
Practice Address - Country:US
Practice Address - Phone:517-244-9170
Practice Address - Fax:517-244-9173
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4132563Medicaid
MIOM86570Medicare ID - Type Unspecified
MI4132563Medicaid