Individual
MICHAEL COOPERSTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
404 N KEENE ST, COLUMBIA, MO 65201-6626
(573) 882-6921
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 882-3974
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
R5666
MO
2080P0208X
Pediatric Infectious Diseases Physician
Primary
R5666
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102434
HEALTHLINK
MO
01
—
11588
BLUE SHIELD
MO
05
—
200527802
—
MO
01
—
2086988101
KANSAS MEDICAID
MO
01
—
9209005
UNITED HEALTHCARE
MO
Enumeration date
05/25/2006
Last updated
03/17/2018
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