Provider Demographics
NPI:1699766642
Name:COOK, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 W CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2776
Mailing Address - Country:US
Mailing Address - Phone:989-667-2370
Mailing Address - Fax:
Practice Address - Street 1:3140 W CAMPUS DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-667-2370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030187207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM006890OtherTRICARE
MI111045159OtherTRAVELERS MEDICARE
MI1065378Medicaid
MI1100979532OtherBLUE CROSS BLUE SHIELD
MI1179532OtherHEALTH PLUS OF MICHIGAN
MI1100979532OtherBLUE CARE NETWORK
MI1004175OtherMCLAREN HEALTH PLAN
MI1004175OtherMCLAREN HEALTH PLAN
MI1100979532OtherBLUE CROSS BLUE SHIELD