Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 230005622360101 | MI |
NPI | 1336745231 |
---|---|
Provider Name | Damekica N Cooper |
First Address | Sterling Heights, MI 48312-5561 |
Second Address | Detroit, MI 48234-3218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2020 |
Last Update Date | 07/12/2020 |