Provider Demographics
NPI:1841237047
Name:COOK, TODD M (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:334 THOMAS MORE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3464
Mailing Address - Country:US
Mailing Address - Phone:859-781-4111
Mailing Address - Fax:859-441-5214
Practice Address - Street 1:125 ST. MICHAEL DRIVE
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-9999
Practice Address - Country:US
Practice Address - Phone:859-781-4111
Practice Address - Fax:859-441-5214
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY18151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0498171Medicaid
KY64181514Medicaid
KYP00839857OtherRAILROAD MEDICARE
KY080092536OtherRAILROAD MEDICARE
KY080092536OtherRAILROAD MEDICARE
KYC70728Medicare UPIN
KY64181514Medicaid