Provider Demographics
NPI:1285920835
Name:COOK, MITCHELL ANDREW (DPM)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ANDREW
Last Name:COOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 W DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5884
Mailing Address - Country:US
Mailing Address - Phone:618-767-6050
Mailing Address - Fax:
Practice Address - Street 1:3329 W DEYOUNG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5884
Practice Address - Country:US
Practice Address - Phone:618-767-6050
Practice Address - Fax:618-294-8203
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005526213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005526OtherILLINOIS STATE LICENSE - PODIATRY