Basic Information
| Provider Information | |||||||||
| NPI: | 1861554321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOPER | ||||||||
| FirstName: | LLOYD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 901 LAKESHORE DR | ||||||||
| Address2: | |||||||||
| City: | ISHPEMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498491367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064852687 | ||||||||
| FaxNumber: | 9064852730 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 LAKESHORE DR | ||||||||
| Address2: | |||||||||
| City: | ISHPEMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498491367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064852687 | ||||||||
| FaxNumber: | 9064852730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 05/12/2014 | ||||||||
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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 | 174400000X | 4301045325 | MI | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 103227297 | 05 | MI | MEDICAID | LH045325 | 01 | MI | BCBS LICENSE | OTHER | P00210384 | 01 | MI | RRMEDICARE | OTHER |