Provider Demographics
NPI:1023002813
Name:COHEN, MITCHELL E (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:E
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 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE 1609
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-203-8664
Mailing Address - Fax:310-286-2184
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1609
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-203-8664
Practice Address - Fax:310-286-2184
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48872207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51201Medicare UPIN
CAG48872Medicare ID - Type Unspecified