Provider Demographics
NPI:1871561233
Name:COOLEY, JOHN R (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:COOLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:STE M351 BRONSON WOMENS SERVICE
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007
Mailing Address - Country:US
Mailing Address - Phone:269-341-8812
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:STE M351 BRONSON WOMENS SERVICE
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007
Practice Address - Country:US
Practice Address - Phone:269-341-7979
Practice Address - Fax:269-341-6261
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301037455207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4770191Medicaid
B46278Medicare UPIN
MIC97618018Medicare ID - Type Unspecified