Provider Demographics
NPI:1558361956
Name:COOK, DENICE D (MD)
Entity Type:Individual
Prefix:DR
First Name:DENICE
Middle Name:D
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DENICE
Other - Middle Name:D
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:31 W 155TH ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-3556
Mailing Address - Country:US
Mailing Address - Phone:708-596-5177
Mailing Address - Fax:708-596-5518
Practice Address - Street 1:31 W 155TH ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3556
Practice Address - Country:US
Practice Address - Phone:708-596-5177
Practice Address - Fax:708-596-5518
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075477208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075477Medicaid
1634171OtherBCBSIL GROUP NUMBER
IL036075477Medicaid
IL209313Medicare PIN
1634171OtherBCBSIL GROUP NUMBER