Provider Demographics
NPI:1487692653
Name:COOKSEY, MICHAEL B (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:COOKSEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 SILVERSIDE RD
Mailing Address - Street 2:SUITE 204 RIDGELY BLDG
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4909
Mailing Address - Country:US
Mailing Address - Phone:302-477-1375
Mailing Address - Fax:302-477-1383
Practice Address - Street 1:3519 SILVERSIDE RD
Practice Address - Street 2:SUITE 204 RIDGELY BLDG
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4909
Practice Address - Country:US
Practice Address - Phone:302-477-1375
Practice Address - Fax:302-477-1383
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20005691207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000013840Medicaid
DE00B237H16Medicare ID - Type Unspecified
DEH31395Medicare UPIN