Provider Demographics
NPI:1487784112
Name:COOPER, MICHAEL LEO (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEO
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 1:440 TERRACE TRL E
Mailing Address - Street 2:
Mailing Address - City:LAKE QUIVIRA
Mailing Address - State:KS
Mailing Address - Zip Code:66217-8505
Mailing Address - Country:US
Mailing Address - Phone:913-268-5068
Mailing Address - Fax:
Practice Address - Street 1:1010 CARONDELET DR STE 308
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4823
Practice Address - Country:US
Practice Address - Phone:816-942-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4834207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C50327Medicare UPIN