Provider Demographics
NPI:1811215312
Name:COOPER-SHELTON, TOSKHAN JAMAAL MARCEL (MD, MBA, MS)
Entity Type:Individual
Prefix:DR
First Name:TOSKHAN
Middle Name:JAMAAL MARCEL
Last Name:COOPER-SHELTON
Suffix:
Gender:M
Credentials:MD, MBA, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8609 TURNSTONE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-9598
Mailing Address - Country:US
Mailing Address - Phone:281-408-3445
Mailing Address - Fax:
Practice Address - Street 1:26 N ARSENAL AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-3808
Practice Address - Country:US
Practice Address - Phone:317-632-0123
Practice Address - Fax:317-423-0608
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072862A208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice