Provider Demographics
NPI:1508081787
Name:COHEN, MATTHEW DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:123 LANSING ST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1696
Mailing Address - Country:US
Mailing Address - Phone:517-541-5954
Mailing Address - Fax:517-541-5944
Practice Address - Street 1:123 LANSING ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1696
Practice Address - Country:US
Practice Address - Phone:517-541-5954
Practice Address - Fax:517-541-5944
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016025207L00000X
OK4747207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine