Provider Demographics
NPI:1144403288
Name:COOK, MICHAEL HEATH S (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HEATH S
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:HEATH
Other - Middle Name:S
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:P.O. BOX 630
Mailing Address - Street 2:
Mailing Address - City:JENKINS
Mailing Address - State:KY
Mailing Address - Zip Code:41537
Mailing Address - Country:US
Mailing Address - Phone:606-832-0023
Mailing Address - Fax:606-832-0054
Practice Address - Street 1:853 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537-9163
Practice Address - Country:US
Practice Address - Phone:606-832-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03226207Q00000X
KYTP778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100036830Medicaid
KYP00478236Medicare PIN
KY7100036830Medicaid