Provider Demographics
NPI:1023009875
Name:COOK, MICHAEL R (DPM)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:COOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8955 SW 87TH COURT
Mailing Address - Street 2:STE 108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2264
Mailing Address - Country:US
Mailing Address - Phone:305-412-1218
Mailing Address - Fax:305-412-4151
Practice Address - Street 1:8955 SW 87TH COURT
Practice Address - Street 2:STE 108
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2264
Practice Address - Country:US
Practice Address - Phone:305-412-1218
Practice Address - Fax:305-412-4151
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1764213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4355616OtherAETNA
FL87977OtherBCBS
FL447744OtherUNITED HEALTHCARE
FL480029345OtherRAILROAD MEDICARE
FL052072100Medicaid
FL4055390001OtherDMERC
FL7380395OtherCIGNA
FL052072100Medicaid
FL4055390001OtherDMERC