Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 2008015959 | MO |
Y | 207L00000X | Anesthesiologist | 57337-20 | WI |
NPI | 1003070095 |
---|---|
Provider Name | Craig R Cook |
First Address | Milwaukee, WI 53233-1305 |
Second Address | Wauwatosa, WI 53222-1613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 10/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
61326 | DEAN HEALTH INSURANCE (01) | WI |