Basic Information
| Provider Information | |||||||||
| NPI: | 1447208475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7580 NORTHCLIFF AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441443270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164722741 | ||||||||
| FaxNumber: | 2164722740 | ||||||||
| Practice Location | |||||||||
| Address1: | 2351 E 22ND ST | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441153111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168616200 | ||||||||
| FaxNumber: | 2163632757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 07/02/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 35057833 | OH | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
| ID | Type | State | Issuer | Description | 341091834009 | 01 | OH | TRICARE | OTHER | P00402409 | 01 | OH | RAILROAD MEDICARE | OTHER | 2765635 | 01 | OH | UNITED HEALTHCARE | OTHER | 000000485841 | 01 | OH | ANTHEM BCBS | OTHER | 5429209 | 01 | OH | AETNA | OTHER | 341091834050 | 01 | OH | MEDICAL MUTUAL | OTHER | 0893458 | 05 | OH | MEDICAID |