Provider Demographics
NPI:1790739712
Name:COOK, STEVEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
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 1:2715 W FRANK ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2593
Mailing Address - Country:US
Mailing Address - Phone:715-832-0707
Mailing Address - Fax:715-834-5870
Practice Address - Street 1:2512 NEW PINE DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-1378
Practice Address - Country:US
Practice Address - Phone:715-832-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2164Z207P00000X, 207PE0004X, 207PP0204X, 207PT0002X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000011010OtherMEDICARE PTAN
WI30188400Medicaid
MN553865300Medicaid
WI30188400Medicaid
000011010OtherMEDICARE PTAN