Provider Demographics
NPI:1366563678
Name:COOK, MICHAEL WATSON (M D)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WATSON
Last Name:COOK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1542 TULANE AVE RM 734
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2865
Mailing Address - Country:US
Mailing Address - Phone:504-568-4750
Mailing Address - Fax:504-568-4633
Practice Address - Street 1:3700 SAINT CHARLES AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-4637
Practice Address - Country:US
Practice Address - Phone:504-412-1325
Practice Address - Fax:504-412-1498
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD 026233208600000X
LAMD.026233208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1049883Medicaid
MS07150071Medicaid
LA1049883Medicaid
LA4M256Medicare PIN