Provider Demographics
NPI:1366458275
Name:COHEN, ADAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:J
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 1:2 E ERIE ST
Mailing Address - Street 2:APT 2605
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2724
Mailing Address - Country:US
Mailing Address - Phone:312-513-7843
Mailing Address - Fax:
Practice Address - Street 1:2591 COMPASS RD
Practice Address - Street 2:SUITE 115
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8043
Practice Address - Country:US
Practice Address - Phone:847-834-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361125402082S0099X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0281300001OtherDMERC
ILBC7331438OtherDEA
ILBC7331438OtherDEA
ILK26826Medicare ID - Type Unspecified