Provider Demographics
NPI:1003861055
Name:COOKINGHAM, GAIL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ANN
Last Name:COOKINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2977
Mailing Address - Country:US
Mailing Address - Phone:810-733-3200
Mailing Address - Fax:810-733-8835
Practice Address - Street 1:2820 STABLE DRIVE
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074
Practice Address - Country:US
Practice Address - Phone:810-985-6800
Practice Address - Fax:810-985-6808
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406723207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E29981Medicare UPIN
MIMI1523003Medicare PIN
OM58080Medicare ID - Type Unspecified