Provider Demographics
NPI:1588669683
Name:COOK, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
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 1:737 N MICHIGAN AVE
Mailing Address - Street 2:STE 2310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2635
Mailing Address - Country:US
Mailing Address - Phone:312-266-6647
Mailing Address - Fax:312-266-6612
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:STE 2310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2635
Practice Address - Country:US
Practice Address - Phone:312-266-6647
Practice Address - Fax:312-266-6612
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074309207ND0101X, 207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL90852Medicare ID - Type Unspecified
IL036074309Medicare ID - Type Unspecified
ILD13619Medicare UPIN