Provider Demographics
NPI:1831120757
Name:COOPER, MICHAEL ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 WINDSOR CENTRE TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1865
Mailing Address - Country:US
Mailing Address - Phone:972-899-8080
Mailing Address - Fax:972-899-8202
Practice Address - Street 1:4300 WINDSOR CENTRE TRL STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1865
Practice Address - Country:US
Practice Address - Phone:972-899-8080
Practice Address - Fax:972-899-8202
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24262174400000X
TXN7912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200064640AMedicaid
TX285380603Medicaid
TX285380603Medicaid
TXTXB137990Medicare PIN
OK244534702Medicare ID - Type Unspecified