MEDICARE: ELIZABETH MICHAELA COOKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AT007033	PA

General Provider Information

NPI Number	:	1063306629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MICHAELA COOKE

Provider Business Mailing Address
First Line	:	1828 GREEN ST APT 1F
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19130-3932
Country	:	US
Telephone Number	:	715-803-3181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 GREEN ST APT 1F
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19130-3932
Country	:	US
Telephone Number	:	715-803-3181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	06/06/2025

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