Basic Information
| Provider Information | |||||||||
| NPI: | 1477553816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COONEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1848 | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494431848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317275211 | ||||||||
| FaxNumber: | 2317274571 | ||||||||
| Practice Location | |||||||||
| Address1: | 2481 N 72ND AVE | ||||||||
| Address2: | |||||||||
| City: | HART | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318732163 | ||||||||
| FaxNumber: | 2318732143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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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 | 207Q00000X | 5101012851 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | CJ0662 | 01 | MI | MEDICARE RAILROAD | OTHER |