Provider Demographics
NPI:1912498445
Name:COOPER, CANDACE (DO)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR STE J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:29370 PLYMOUTH RD STE 100
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2399
Practice Address - Country:US
Practice Address - Phone:347-655-8200
Practice Address - Fax:734-655-8210
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine