Provider Demographics
NPI:1073864526
Name:COOK, MICHAEL DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:COOK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4790 BARKLEY CIR
Mailing Address - Street 2:STE A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7593
Mailing Address - Country:US
Mailing Address - Phone:239-275-8882
Mailing Address - Fax:239-938-7660
Practice Address - Street 1:8931 COLONIAL CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7809
Practice Address - Country:US
Practice Address - Phone:239-277-5770
Practice Address - Fax:239-985-1911
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106839363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01122938OtherRAILROAD MCR
FLP944516OtherOPTIMUM:
FLY0EH3OtherBCBS FL
FL9061842OtherAETNA
FLP1004405OtherFREEDOM HEALTH
FL9061842OtherAETNA