Provider Demographics
NPI:1558445015
Name:DAVID L. COOLEY D.O. P.C.
Entity Type:Organization
Organization Name:DAVID L. COOLEY D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-562-1985
Mailing Address - Street 1:3902 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2545
Mailing Address - Country:US
Mailing Address - Phone:313-562-1985
Mailing Address - Fax:313-562-0380
Practice Address - Street 1:3902 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2545
Practice Address - Country:US
Practice Address - Phone:313-562-1985
Practice Address - Fax:313-562-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDC006823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI120001978OtherRAILROAD MEDICARE TRAVELERS
MI0P44490Medicare PIN