Individual
DR. DIANE S. COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2606 PEDDLERS VILLAGE RD, SUITE 200, GOSHEN, IN 46526-1004
(574) 534-6065
(574) 534-6037
Mailing address
2606 PEDDLERS VILLAGE RD, SUITE 200, GOSHEN, IN 46526-1004
(574) 534-6065
(574) 534-6037
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01040345A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100114420A
—
IN
Enumeration date
07/15/2005
Last updated
10/19/2011
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