Basic Information
| Provider Information | |||||||||
| NPI: | 1407080286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOLEY | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | JOANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BIESIADA | ||||||||
| OtherFirstName: | THERESA | ||||||||
| OtherMiddleName: | JOANN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 17717 MASONIC BLVD | ||||||||
| Address2: | |||||||||
| City: | FRASER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862940600 | ||||||||
| FaxNumber: | 5862942525 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 SOUTH BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103422401 | ||||||||
| FaxNumber: | 8103422271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2009 | ||||||||
| LastUpdateDate: | 05/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4301 094 027 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.