Healthcare Provider Details

I. General information

NPI: 1417979683
Provider Name (Legal Business Name): CHRISTINE LOUISE COOK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST SUITE 410
LOUISVILLE KY
40202-5700
US

IV. Provider business mailing address

550 S JACKSON ST FL ST2 DEPT OB/GYN
LOUISVILLE KY
40202-1622
US

V. Phone/Fax

Practice location:
  • Phone: 502-271-5999
  • Fax: 502-271-5994
Mailing address:
  • Phone:
  • Fax: 502-561-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number16317
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: