Provider Demographics
NPI:1316905250
Name:COOK, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10109 E. 79TH STREET
Mailing Address - Street 2:CANCER TREATMENT CENTERS OF AMERICA
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-296-8060
Mailing Address - Fax:918-516-0445
Practice Address - Street 1:10109 E. 79TH STREET
Practice Address - Street 2:CANCER TREATMENT CENTERS OF AMERICA
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-296-8060
Practice Address - Fax:918-516-0445
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK17687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK110190960Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OKF53906Medicare UPIN
OK100119520AMedicaid