Provider Demographics
NPI:1508952011
Name:COOK, EDWIN JOHN (DO)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:JOHN
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:EDWIN
Other - Middle Name:J
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4001 VOLLMER RD
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-3168
Mailing Address - Country:US
Mailing Address - Phone:708-481-8883
Mailing Address - Fax:708-679-5354
Practice Address - Street 1:4001 VOLLMER RD.
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461
Practice Address - Country:US
Practice Address - Phone:708-481-8883
Practice Address - Fax:708-481-2917
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054673207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054673Medicaid
IL036054673Medicaid
ILD14332Medicare UPIN