Provider Demographics
NPI:1447359039
Name:COOPERSMITH, KATHIE ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHIE
Middle Name:ELLEN
Last Name:COOPERSMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5495 S 500 E
Mailing Address - Street 2:STE 120
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6923
Mailing Address - Country:US
Mailing Address - Phone:801-479-0174
Mailing Address - Fax:801-479-8888
Practice Address - Street 1:5495 S 500 E
Practice Address - Street 2:STE 120
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6923
Practice Address - Country:US
Practice Address - Phone:801-479-0174
Practice Address - Fax:801-479-8888
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT181607-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT841409599001Medicaid
UT841409599001Medicaid