# WELDON COOKE MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912233875
- **Authorized official:** WELDON JOHN COOKE MD FACS (OWNER- MD)
- **Authorized official phone:** (219) 871-2500

## Contact information

- **Practice address:** 10176 W. 400 NORTH, SUITE C, MICHIGAN CITY, IN 46360
- **Practice address phone:** (219) 873-1777
- **Practice address fax:** (219) 873-0001
- **Mailing address:** 3965 N. MALAGA DR, LAPORTE, IN 46350
- **Mailing address phone:** (219) 873-1777
- **Mailing address fax:** (219) 873-0001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01020627B | IN | Yes |

## Other

- **Enumeration date:** 10/28/2009
- **Last updated:** 12/30/2014