Healthcare Provider Details

I. General information

NPI: 1750356341
Provider Name (Legal Business Name): MICHAEL E COOKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 GOSS RD FOX ARMY HEALTH CENTER, PRIMARY CARE CLINIC
REDSTONE ARSENAL AL
35809-7000
US

IV. Provider business mailing address

4100 GOSS RD FOX ARMY HEALTH CENTER, CREDENTIALS COORDINATOR
REDSTONE ARSENAL AL
35809-7000
US

V. Phone/Fax

Practice location:
  • Phone: 256-876-4560
  • Fax: 256-313-3260
Mailing address:
  • Phone: 256-876-4560
  • Fax: 256-313-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-74
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: