Provider Demographics
NPI:1013009364
Name:COHEN, PHILIP TEPPER (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:TEPPER
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5154 JUNEAU RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4744
Mailing Address - Country:US
Mailing Address - Phone:608-441-2512
Mailing Address - Fax:608-441-2512
Practice Address - Street 1:5154 JUNEAU RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4744
Practice Address - Country:US
Practice Address - Phone:608-441-2512
Practice Address - Fax:608-441-2512
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48665-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A44945Medicare UPIN