MEDICARE: DR. LORI MICHELLE 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	208000000X	Pediatrics Physician	LL29955	SC
2	208000000X	Pediatrics Physician	MD.203604	LA

General Provider Information

NPI Number	:	1891999611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI MICHELLE COOK M.D.

Provider Business Mailing Address
First Line	:	8040 GOODWOOD BLV
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7631
Country	:	US
Telephone Number	:	225-928-0867
Fax Number	:	225-928-1948

Provider Business Practice Location Address
First Line	:	8040 GOODWOOD BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7631
Country	:	US
Telephone Number	:	225-928-0867
Fax Number	:	225-928-1948

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	03/27/2019

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