Provider Information for 1316461262
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DUSTIN COOLEY
Sex: Male
NPI: 1316461262
Last Updated: 2022-02-21
Certification Date: 2022-02-08
Certification Date: 2022-02-08
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1316461262 | ||||||||
| Enumeration Date | 2017-08-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 424 WARDS CORNER RD STE 200 LOVELAND, OH 45140-6966 United States Phone: 513-576-7700 | Fax:513-576-1020 | ||||||||
| Primary Practice Address | 631 EAST ST. STREET GEORGETOWN, OH 45121-1437 United States Phone: 937-378-6387 | Fax:937-378-4253 | ||||||||
| Secondary Practice Address(es) | 218 STERN RD | ||||||||
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