Individual
DR. DWAYNE L.. COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 56TH ST SW, WYOMING, MI 49509-9704
(616) 243-5707
(616) 243-1170
Mailing address
8485 ALGOMA AVE NE, ROCKFORD, MI 49341-9102
(616) 863-6220
(616) 863-6221
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301074284
MI
208000000X
Pediatrics Physician
4301074284
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11274020
CAQH
MI
Enumeration date
03/16/2006
Last updated
12/20/2007
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