Provider Demographics
NPI:1851354211
Name:COOK, CURTIS R (MD)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:R
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 1:100 MICHIGAN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1727 W FRYE RD STE 200
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5298
Practice Address - Country:US
Practice Address - Phone:480-728-5463
Practice Address - Fax:480-728-5449
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054518207VM0101X
AZ41202207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558407189OtherGROUP NPI
MI4496502Medicaid
MI0D16228005Medicare ID - Type Unspecified
MIF58629Medicare UPIN