Provider Demographics
NPI:1356487904
Name:COOK, MARISHA L (M D)
Entity Type:Individual
Prefix:
First Name:MARISHA
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:M D
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Other - First Name:
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Mailing Address - Street 1:2300 N ROCKTON AVE
Mailing Address - Street 2:ALLERGY DEPT
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3619
Mailing Address - Country:US
Mailing Address - Phone:815-971-2000
Mailing Address - Fax:815-971-2585
Practice Address - Street 1:2300 N ROCKTON AVE
Practice Address - Street 2:ALLERGY DEPT
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3619
Practice Address - Country:US
Practice Address - Phone:815-971-2000
Practice Address - Fax:815-971-2585
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2015-07-09
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Provider Licenses
StateLicense IDTaxonomies
IL036128205207KA0200X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL616040130Medicare UPIN