Provider Demographics
NPI:1033204854
Name:COHEN, MICHAEL D (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 N LINAM ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-5128
Mailing Address - Country:US
Mailing Address - Phone:575-393-2293
Mailing Address - Fax:575-393-2293
Practice Address - Street 1:1006 N LINAM ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-5128
Practice Address - Country:US
Practice Address - Phone:575-393-2293
Practice Address - Fax:575-393-2293
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM125213E00000X
TX553213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52233Medicaid
NMNM005329OtherBC-BS
NMNM005329OtherBC-BS
U04009Medicare UPIN
NM0621960001Medicare NSC