Individual
KEVIN D COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-8200
(216) 286-6341
Mailing address
11100 EUCLID AVE FL 3, CLEVELAND, OH 44106-1716
(216) 844-3111
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
35-068611
OH
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
Primary
35-068611
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000140401
ANTHEM
OH
01
—
000000221135
UNISON
—
01
—
000000523162
ANTHEM
OH
05
—
0019479400002
—
PA
05
—
0161908
—
OH
01
—
1049435
AETNA
OH
01
—
363444
WELLCARE
—
01
—
70013591
RAILROAD MEDICARE
OH
01
—
742206
BUCKEYE
—
Enumeration date
07/18/2006
Last updated
12/17/2020
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