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General NPI Number Information
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NPI Number | 1386768588
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Entity Type | Individual
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Provider Name | GERALD L COOKE MD
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 6127 S UNIVERSITY AVE
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City | CHICAGO
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State | IL
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Zip | 60637-5894
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Country | US
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Telephone | 708-444-2310
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Fax | 888-509-9868
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Provider Business Mailing Address
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Address Line | 4906 S GREENWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60615-2816
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Country | US
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Telephone | 773-936-5376
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036-109316
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-109316
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License Number State | IL
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