Provider Demographics
NPI:1942610019
Name:COOKE, KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:COOKE
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 1:2200 E SEMORAN BLVD STE 226
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5733
Mailing Address - Country:US
Mailing Address - Phone:407-880-0011
Mailing Address - Fax:407-880-7792
Practice Address - Street 1:2200 E SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5733
Practice Address - Country:US
Practice Address - Phone:407-880-0011
Practice Address - Fax:407-880-7792
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJB17ZOtherMEDICARE
FL022124900Medicaid