Provider Demographics
NPI:1376514182
Name:COHEN, DELLA D (MD)
Entity Type:Individual
Prefix:
First Name:DELLA
Middle Name:D
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3698
Mailing Address - Country:US
Mailing Address - Phone:313-581-2600
Mailing Address - Fax:313-581-2786
Practice Address - Street 1:4700 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3698
Practice Address - Country:US
Practice Address - Phone:313-581-2600
Practice Address - Fax:313-581-2786
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045654207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H261380OtherBCBSM
MIF06143OtherMCARE
MI4461632Medicaid
MI4461641Medicaid
MI4409140Medicaid
MI160F376930OtherBCBSM
MI382279274OtherALL COMMERICAL
MIW46599Medicare UPIN
MI0H26138035Medicare ID - Type Unspecified
MI4409140Medicaid