Provider Demographics
NPI:1740626514
Name:COOK, WILLIAM A (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
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 1:6318 BARNARD MILL RD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60072-9637
Mailing Address - Country:US
Mailing Address - Phone:815-354-3451
Mailing Address - Fax:
Practice Address - Street 1:6318 BARNARD MILL RD
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:IL
Practice Address - Zip Code:60072-9637
Practice Address - Country:US
Practice Address - Phone:815-354-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043382208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043382Medicaid
492000Medicare PIN
IL036043382Medicaid