Provider Demographics
NPI:1326330853
Name:COOKE MEDICAL, LLC
Entity Type:Organization
Organization Name:COOKE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:LYNZIE
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-815-6668
Mailing Address - Street 1:16750 80TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3173
Mailing Address - Country:US
Mailing Address - Phone:877-815-6668
Mailing Address - Fax:877-815-4960
Practice Address - Street 1:16750 80TH AVE
Practice Address - Street 2:STE A
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3173
Practice Address - Country:US
Practice Address - Phone:877-815-6668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty