Provider Demographics
NPI:1154508612
Name:DAVID A COOK MD PC
Entity Type:Organization
Organization Name:DAVID A COOK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-893-3551
Mailing Address - Street 1:3140 W CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2776
Mailing Address - Country:US
Mailing Address - Phone:989-893-3551
Mailing Address - Fax:989-671-9275
Practice Address - Street 1:3140 W CAMPUS DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2776
Practice Address - Country:US
Practice Address - Phone:989-893-3551
Practice Address - Fax:989-671-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1179532OtherHEALTH PLUS OF MI
MI1004175OtherMCLAREN HEALTH ADVANTAGE
MI1100979532OtherBLUE CROSS BLUE SHIELD
MI1100979532OtherBLUE CARE NETWORK
GA111045159OtherPALMETTO GBA
MI1004175OtherMCLAREN HEALTH PLAN
MI1065378Medicaid
GA111045159OtherPALMETTO GBA
MID91260Medicare UPIN