Provider Demographics
NPI:1164866430
Name:COOPER, MARK GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GREGORY
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:310 LAFAYETTE AVE SE STE 400
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4693
Mailing Address - Country:US
Mailing Address - Phone:616-752-6525
Mailing Address - Fax:616-752-6556
Practice Address - Street 1:310 LAFAYETTE AVE SE STE 400
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4693
Practice Address - Country:US
Practice Address - Phone:616-752-6525
Practice Address - Fax:616-752-6556
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ6313207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine