Provider Demographics
NPI:1730310814
Name:KOOKESH, MATTHEW III (IOMT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KOOKESH
Suffix:III
Gender:M
Credentials:IOMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 OAKRIDGE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5564
Mailing Address - Country:US
Mailing Address - Phone:877-377-9555
Mailing Address - Fax:
Practice Address - Street 1:1300 OAKRIDGE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5564
Practice Address - Country:US
Practice Address - Phone:877-377-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic