Provider Demographics
NPI:1811038102
Name:COOK, JOHN Q (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:Q
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 1:118 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-4007
Mailing Address - Country:US
Mailing Address - Phone:847-446-7562
Mailing Address - Fax:847-446-7658
Practice Address - Street 1:118 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-4007
Practice Address - Country:US
Practice Address - Phone:847-446-7562
Practice Address - Fax:847-446-7658
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31602921OtherBLUE CROSS NUMBER
ILC44425Medicare UPIN
IL793720Medicare ID - Type Unspecified