Provider Demographics
NPI:1386603439
Name:COOK, HARLAND L (PA)
Entity type:Individual
Prefix:
First Name:HARLAND
Middle Name:L
Last Name:COOK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2315 N LAKE DRIVE
Mailing Address - Street 2:#703
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211
Mailing Address - Country:US
Mailing Address - Phone:414-271-5119
Mailing Address - Fax:414-271-3756
Practice Address - Street 1:2315 M LAKE DRIVE
Practice Address - Street 2:#703
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:414-271-5119
Practice Address - Fax:414-271-3756
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2020-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI1090023363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42978100Medicaid
WI001168870Medicare PIN
WI42978100Medicaid