Provider Demographics
NPI:1316034093
Name:COOK, KATHY P (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:P
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:LYNN
Other - Last Name:PERISHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-7190
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:SUITE 113
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6083
Practice Address - Country:US
Practice Address - Phone:515-232-3006
Practice Address - Fax:515-232-3009
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA26734207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI12328Medicare PIN
IAE92166Medicare UPIN