MEDICARE: DR. THOMAS J COOK M.D.

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	207Q00000X	Family Medicine Physician	TC025978	MI

General Provider Information

NPI Number	:	1073507158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J COOK M.D.

Provider Business Mailing Address
First Line	:	346 LONG RAPIDS PLZ
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-1374
Country	:	US
Telephone Number	:	989-358-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	346 LONG RAPIDS PLZ
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-1374
Country	:	US
Telephone Number	:	989-358-3500
Fax Number	:

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	03/17/2018

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