Provider Demographics
NPI:1275163008
Name:COOK, MICHAEL EUGENE
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:COOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E 232ND ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1502
Mailing Address - Country:US
Mailing Address - Phone:216-645-7902
Mailing Address - Fax:
Practice Address - Street 1:310 E 232ND ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1502
Practice Address - Country:US
Practice Address - Phone:216-645-7902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0001639175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist