Provider Demographics
NPI:1043315666
Name:KOOKEN, ANN R (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:R
Last Name:KOOKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3624 W MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4510
Mailing Address - Country:US
Mailing Address - Phone:330-665-0555
Mailing Address - Fax:330-665-0556
Practice Address - Street 1:3624 W MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4510
Practice Address - Country:US
Practice Address - Phone:330-665-0555
Practice Address - Fax:330-665-0556
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35081935K207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2376414Medicaid
OHKO4102853Medicare PIN
OHH80397Medicare UPIN