MEDICARE: DR. PENALOPE D. COOK D.O.

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	208D00000X	General Practice Physician	PC006961	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	386004447003	OTHER	MI	TRICARE

General Provider Information

NPI Number	:	1487612685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENALOPE D. COOK D.O.

Provider Business Mailing Address
First Line	:	1266 BRUDER RD
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-9581
Country	:	US
Telephone Number	:	989-773-1667
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E. PRESTON
Second Line	:	CMU HEALTH SERVICES, FOUST HALL 108
City	:	MT PLEASANT
State	:	MI
Zip	:	48859-0001
Country	:	US
Telephone Number	:	989-774-1748
Fax Number	:	989-774-4335

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. PENALOPE D. COOK D.O.” Practice Location

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