Provider Demographics
NPI:1598752164
Name:COOPER, MILISSA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:MILISSA
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:DO
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Other - First Name:
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Mailing Address - Street 1:7699 E PINNACLE PEAK RD STE 115
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6322
Mailing Address - Country:US
Mailing Address - Phone:480-300-4663
Mailing Address - Fax:602-336-0044
Practice Address - Street 1:7699 E PINNACLE PEAK RD STE 115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6322
Practice Address - Country:US
Practice Address - Phone:480-300-4663
Practice Address - Fax:480-300-4888
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG05595Medicare UPIN
AZ20WCLCA06Medicare PIN