Provider Demographics
NPI:1639175342
Name:COOK, STEPHEN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHRISTOPHER
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-4959
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:5330 E STOP 11 RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6345
Practice Address - Country:US
Practice Address - Phone:317-893-1900
Practice Address - Fax:317-893-1901
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01085224A207RA0002X, 207RC0000X
MI43011090932080P0202X, 2080P0202X
OH35079172208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCO4165441OtherOHIO MEDICARE
OH2247349Medicaid
OHCO4165443OtherOHIO MEDICARE