Healthcare Provider Details

I. General information

NPI: 1306335344
Provider Name (Legal Business Name): BRANDON ARTHUR COOK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21202 OWENS RD STE 300
MOKENA IL
60448-2038
US

IV. Provider business mailing address

21202 OWENS RD STE 300
MOKENA IL
60448-2038
US

V. Phone/Fax

Practice location:
  • Phone: 779-334-0100
  • Fax: 779-334-0051
Mailing address:
  • Phone: 779-334-0100
  • Fax: 779-334-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.005183
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085010293
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: