Basic Information
| Provider Information | |||||||||
| NPI: | 1730477324 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | TEETHENA | ||||||||
| MiddleName: | COMEKO | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 W RAMPART ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461768846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174212012 | ||||||||
| FaxNumber: | 3173981851 | ||||||||
| Practice Location | |||||||||
| Address1: | 2451 INTELLIPLEX DR | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461768580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173923211 | ||||||||
| FaxNumber: | 3173981851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2011 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 125.056191 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 01078084A | IN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.