Healthcare Provider Details

I. General information

NPI: 1356549810
Provider Name (Legal Business Name): LOLA P. COOK MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8091 TOWNSHIP LINE RD SUITE 108
INDIANAPOLIS IN
46260-2494
US

IV. Provider business mailing address

5098 SAINT CHARLES PL
CARMEL IN
46033-5940
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-8100
  • Fax: 317-415-7734
Mailing address:
  • Phone: 317-345-5652
  • Fax: 317-415-7734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: