Provider Demographics
NPI:1548564164
Name:DECOOK, JOSEPH LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEE
Last Name:DECOOK
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 1:2238 TONY AVE
Mailing Address - Street 2:
Mailing Address - City:FENNVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49408-9463
Mailing Address - Country:US
Mailing Address - Phone:616-644-5313
Mailing Address - Fax:
Practice Address - Street 1:2238 TONY AVE
Practice Address - Street 2:
Practice Address - City:FENNVILLE
Practice Address - State:MI
Practice Address - Zip Code:49408-9463
Practice Address - Country:US
Practice Address - Phone:616-644-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301024771207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology