Provider Demographics
NPI:1417979683
Name:COOK, CHRISTINE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S JACKSON ST FL ST2
Mailing Address - Street 2:DEPT OB/GYN
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:502-561-2405
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-271-5999
Practice Address - Fax:502-271-5994
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16317207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049405OtherPASSPORT PCP# - FOUNDATION
KY64163173Medicaid
KY1049410OtherPASSPORT SPECIALITY # - PSC
IN100332320Medicaid
KY000000045430OtherANTHEM PSC
KY00000047617OtherANTHEM - FOUNDATION
KY1164929OtherPASSPORT PCP# - FOUNDATION
KY1164929OtherPASSPORT PCP# - FOUNDATION
KY64163173Medicaid
KY1275702Medicare ID - Type Unspecified