Provider Demographics
NPI:1528025871
Name:COOLEY, DAVID L (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:COOLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 MONROE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125
Mailing Address - Country:US
Mailing Address - Phone:313-562-1985
Mailing Address - Fax:313-562-0380
Practice Address - Street 1:3902 MONROE
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125
Practice Address - Country:US
Practice Address - Phone:313-562-1985
Practice Address - Fax:313-562-0380
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDC006823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI120001978OtherRAILROAD MEDICARE TRAVELR
MI5823656OtherBLUE CROSS OF MICHIGAN
MI5823656OtherBLUE CARE NETWORK
MI109509011Medicaid
MI109509011Medicaid
MI109509011Medicaid
MI382213873OtherEIN NUMBER