Healthcare Provider Details

I. General information

NPI: 1205066834
Provider Name (Legal Business Name): DEBORAH L. COOK, DPM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD SUITE 240
CLEVELAND OH
44104-3869
US

IV. Provider business mailing address

11201 SHAKER BLVD SUITE 240
CLEVELAND OH
44104-3869
US

V. Phone/Fax

Practice location:
  • Phone: 440-669-2001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number36003231
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003231
License Number StateOH

VIII. Authorized Official

Name: DR. DEBORAH LYNN COOK
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 440-669-2001