Provider Demographics
NPI:1508891219
Name:COOK, LYNN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:SCOTT
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14717 N 740 EAST RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61858-9410
Mailing Address - Country:US
Mailing Address - Phone:217-377-5768
Mailing Address - Fax:
Practice Address - Street 1:409 W OAK ST STE 202
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1464
Practice Address - Country:US
Practice Address - Phone:618-529-0555
Practice Address - Fax:618-529-0556
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360797232086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1508891219OtherNPI
IL214881Medicare Oscar/Certification
ILD04461Medicare UPIN
IL1508891219OtherNPI
IL6447860011Medicare NSC
ILIL3270267Medicare PIN