Organization
COOPERCARE AZ, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILISSA ANN COOPER DO (OWNER)
(623) 582-2355
Entity
Organization
Contact information
Practice address
20033 N 19TH AVE STE 111, PHOENIX, AZ 85027-4247
(623) 582-2355
Mailing address
20033 N 19TH AVE STE 111, PHOENIX, AZ 85027-4247
(623) 582-2355
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
354126
—
AZ
01
—
AZ0394570
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
02/02/2023
Last updated
02/02/2023
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