Provider Demographics
NPI:1902873904
Name:BROWN-COOK, CHERYL R (DPM)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:BROWN-COOK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 CARLEMONT DR STE M
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1836
Mailing Address - Country:US
Mailing Address - Phone:815-356-5060
Mailing Address - Fax:815-356-7898
Practice Address - Street 1:1520 CARLEMONT DR STE M
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1836
Practice Address - Country:US
Practice Address - Phone:815-356-5060
Practice Address - Fax:815-356-7898
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004864213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480026032OtherRAIL ROAD MEDICARE
IL1625610OtherBCBS
ILU71918Medicare UPIN
ILK30987Medicare PIN
IL473840Medicare PIN