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Individual

KASSANDRA IVA MARIE COOPER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-6710
Mailing address
4601 DALE RD, MODESTO, CA 95356-9718
(209) 689-1492

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
125065930
IL
207P00000X
Emergency Medicine Physician
Primary
20A15660
CA

Other

Enumeration date
07/08/2014
Last updated
11/14/2024
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