Provider Demographics
NPI:1285208926
Name:COOK, ERIC JOSEPH JR (PA-C)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOSEPH
Last Name:COOK
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1209
Mailing Address - Country:US
Mailing Address - Phone:815-200-0363
Mailing Address - Fax:
Practice Address - Street 1:1605 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1209
Practice Address - Country:US
Practice Address - Phone:815-200-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126292363A00000X
IL085.008299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant