Provider Demographics
NPI:1609850817
Name:COOKE, MICHAEL J (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:COOKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SMITH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2787
Mailing Address - Country:US
Mailing Address - Phone:513-619-6885
Mailing Address - Fax:513-533-6001
Practice Address - Street 1:2859 BOUDINOT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-1606
Practice Address - Country:US
Practice Address - Phone:513-662-3900
Practice Address - Fax:513-662-3933
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001985213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0443603Medicaid
OHT80494Medicare UPIN
OH0484364Medicare PIN
0698420003Medicare NSC
480024962Medicare PIN