NPI Code Detail JSON Logo

1104814912 NPI number — J WESLEY COOK D.O.

NPI Number: 1104814912
Health Care Provider/Practitioner: J WESLEY COOK D.O.

Information about “1104814912” NPI (J WESLEY COOK D.O.) exists in 1104814912 in HTML format HTML  |  1104814912 in plain Text format TXT  |  1104814912 in PDF (Portable Document Format) PDF  |  1104814912 in an XML format XML  formats.

NPI Number : 1104814912 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104814912",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COOK",
    "FirstName": "J",
    "MiddleName": "WESLEY",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.O.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4101 N RAVENSWOOD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60613-2193",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-285-6400",
    "MailingAddressFaxNumber": "773-498-3096",
    "FirstLinePracticeLocationAddress": "5801 W CORCORAN PL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60644",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "773-285-6400",
    "PracticeLocationAddressFaxNumber": "773-498-3096",
    "EnumerationDate": "10/06/2005",
    "LastUpdateDate": "03/22/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": "36080259",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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