Provider Demographics
NPI:1720763626
Name:COOLEY, MARQUIS TORIANO
Entity Type:Individual
Prefix:
First Name:MARQUIS
Middle Name:TORIANO
Last Name:COOLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 BRIARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3172
Mailing Address - Country:US
Mailing Address - Phone:803-825-8604
Mailing Address - Fax:
Practice Address - Street 1:5890 BRIARWOOD CT
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3172
Practice Address - Country:US
Practice Address - Phone:803-825-8604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator