Provider Demographics
NPI:1669461992
Name:VORENKAMP-COOPER, CAROL A (DO)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:VORENKAMP-COOPER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HEALTH PARK DR
Mailing Address - Street 2:STE 101
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1296
Mailing Address - Country:US
Mailing Address - Phone:989-729-2255
Mailing Address - Fax:989-729-4050
Practice Address - Street 1:100 HEALTH PARK DR
Practice Address - Street 2:STE 101
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1296
Practice Address - Country:US
Practice Address - Phone:989-729-2255
Practice Address - Fax:989-729-4050
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1669461992Medicaid
MIE80712Medicare UPIN
MIN53550101Medicare PIN
MI4234486OtherAETNA
MIE80712OtherHEALTH NET FEDERAL
MI0980249OtherHEALTH PLUS
MIE80712Medicare UPIN
MI0N53550Medicare PIN
MI080094748OtherMETRAHEALTH
MI201537OtherMCLAREN HEALTH PLAN
MI3331114Medicaid
MIE80712OtherHEALTH ALLIANCE PLAN
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI0N53550101Medicare PIN
MIC2028OtherMCARE
MI2657574001OtherCIGNA
MI201537OtherHEALTH ADVANTAGE NETWORK
MI0M28430Medicare ID - Type Unspecified