Provider Demographics
NPI:1326101304
Name:CYNTHIA L COOKINGHAM MD PC
Entity Type:Organization
Organization Name:CYNTHIA L COOKINGHAM MD PC
Other - Org Name:CLARKSTON ALLERGY AND ASTHMA CLINIC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOKINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-620-1900
Mailing Address - Street 1:5885 S MAIN STREET
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346
Mailing Address - Country:US
Mailing Address - Phone:248-620-1900
Mailing Address - Fax:248-620-1904
Practice Address - Street 1:5885 S MAIN STREET
Practice Address - Street 2:SUITE #1
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-620-1900
Practice Address - Fax:248-620-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICC048327207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4322960Medicaid
MI4322960Medicaid
F05596Medicare UPIN