MEDICARE: ALLAN R COOKE 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	207RG0100X	Gastroenterology Physician	04-16724	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05773078	OTHER	MO	BCBS KC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	625480	OTHER	KS	FIRSTGUARD

General Provider Information

NPI Number	:	1255434163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLAN R COOKE M.D.

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	RM 4035 WESCOE MAILSTOP 1023
City	:	KANSAS CITY
State	:	KS
Zip	:	66160
Country	:	US
Telephone Number	:	913-588-6003
Fax Number	:	913-588-3975

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	RM 4035 WESCOE MAILSTOP 1023
City	:	KANSAS CITY
State	:	KS
Zip	:	66160
Country	:	US
Telephone Number	:	913-588-6000
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	05/29/2014

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Directions to “ ALLAN R COOKE M.D.” Practice Location

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