Basic Information
| Provider Information | |||||||||
| NPI: | 1699749770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOKE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471021303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127948100 | ||||||||
| FaxNumber: | 8127948200 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127948100 | ||||||||
| FaxNumber: | 8127948200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 07/03/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 01056407A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207QA0401X | 01056407A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207Q00000X | 01056407A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200392200 | 05 | IN | MEDICAID | 200490500A | 05 | IN | MEDICAID |