# COOPERCARE AZ, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922704808
- **Authorized official:** MILISSA ANN COOPER DO (OWNER)
- **Authorized official phone:** (623) 582-2355

## Contact information

- **Practice address:** 20033 N 19TH AVE STE 111, PHOENIX, AZ 85027-4247
- **Practice address phone:** (623) 582-2355
- **Mailing address:** 20033 N 19TH AVE STE 111, PHOENIX, AZ 85027-4247
- **Mailing address phone:** (623) 582-2355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/02/2023
- **Last updated:** 02/02/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 354126 | — | AZ |
| 01 | — | AZ0394570 | BLUE CROSS BLUE SHIELD | AZ |