Provider Demographics
NPI:1356380273
Name:COOK, JOHN M (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
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 1:1001 S HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801
Mailing Address - Country:US
Mailing Address - Phone:906-779-1290
Mailing Address - Fax:906-779-2154
Practice Address - Street 1:1001 S HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801
Practice Address - Country:US
Practice Address - Phone:906-779-1290
Practice Address - Fax:906-779-2154
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043588207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30387400OtherWISCONSIN MEDICAID
MI1429186Medicaid
WI382396677017OtherWISCONSIN BCBS
MI1429186Medicaid