Provider Demographics
NPI:1023565124
Name:BARBARA J. COOK, M.D., LLC
Entity type:Organization
Organization Name:BARBARA J. COOK, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-314-8328
Mailing Address - Street 1:104 N KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-7701
Mailing Address - Country:US
Mailing Address - Phone:402-314-8328
Mailing Address - Fax:
Practice Address - Street 1:104 N KENNEDY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-7701
Practice Address - Country:US
Practice Address - Phone:402-314-8328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20860207U00000X
KS04-38755207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE20860OtherNEBRASKA MEDICAL LICENSE
KS04-38755OtherKANSAS MEDICAL LICENSE
KS04-38755OtherKANSAS MEDICAL LICENSE
KSFC5899755OtherKS DEA