MEDICARE: MR. MICHAEL DAVID COOK PA-C

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9106839	FL
2	363AS0400X	Surgical Physician Assistant	PA9106839	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01122938	OTHER	FL	RAILROAD MCR
2	P944516	OTHER	FL	OPTIMUM:
3	Y0EH3	OTHER	FL	BCBS FL
4	9061842	OTHER	FL	AETNA
5	P1004405	OTHER	FL	FREEDOM HEALTH
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1073864526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL DAVID COOK PA-C

Provider Business Mailing Address
First Line	:	PO BOX 7410884
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0884
Country	:	US
Telephone Number	:	702-899-0595
Fax Number	:	702-977-1496

Provider Business Practice Location Address
First Line	:	3250 WINKLER AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-9414
Country	:	US
Telephone Number	:	872-231-3162
Fax Number	:	702-977-1496

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

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	10/07/2025

3250 WINKLER AVENUE EXT
FORT MYERS, FL
33916-9414

Practice Phone: 239-939-4993
Practice Fax: 239-939-1743