Provider Demographics
NPI:1023015419
Name:COHEN, ISAAC I (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:I
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 1:901 PATIENTS FIRST DRIVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:636-390-1400
Mailing Address - Fax:636-390-1439
Practice Address - Street 1:901 PATIENTS FIRST DRIVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4700
Practice Address - Country:US
Practice Address - Phone:636-390-1600
Practice Address - Fax:636-390-1601
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-068229207RH0003X
MO20100002678207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068229Medicaid
IL036068229Medicaid
ILD16502Medicare UPIN