Provider Demographics
NPI:1568458115
Name:COHEN, MICHAEL RANDY (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RANDY
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 VILLAGE SQUARE XING STE 290
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4552
Mailing Address - Country:US
Mailing Address - Phone:239-232-1180
Mailing Address - Fax:
Practice Address - Street 1:950 N COLLIER BLVD STE 303
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2716
Practice Address - Country:US
Practice Address - Phone:239-642-3337
Practice Address - Fax:239-642-3053
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9060207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1225218076OtherGROUP NPI
MI140719OtherCARE CHOICE
MI1568458115OtherNPI
MI756312734OtherBCBS OF MICHIGNA
MI2542386OtherCIGNA
MIP00286013OtherMEDICARE RAILROAD CARRIER
MI7853616OtherAETNA
MI16887OtherM CARE
MI000000011990Medicaid
MII16649OtherHAP
MI140719OtherCARE CHOICE
MI1568458115OtherNPI