Provider Demographics
NPI:1588642177
Name:COOPER, MARIA J (NP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:J
Last Name:COOPER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING/PAYER CONTRACTING
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:734-632-0182
Practice Address - Street 1:33155 ANNAPOLIS ST
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2405
Practice Address - Country:US
Practice Address - Phone:734-467-4042
Practice Address - Fax:734-467-5500
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-07-20
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Provider Licenses
StateLicense IDTaxonomies
MI4704163416363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588642177Medicaid
P40010022Medicare PIN
S74697Medicare UPIN
MI1588642177Medicaid
N87440033Medicare PIN
MIN511650005Medicare PIN
Q24594249Medicare PIN