Provider Demographics
NPI:1568661239
Name:COHEN, MICHELE MARIE-LIZ (DO)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE-LIZ
Last Name:COHEN
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9234
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA - CARDIOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-4040
Practice Address - Fax:267-426-9800
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2018-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB084175002080P0202X
NY2377652080P0202X
PAOS0148152080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022100190002Medicaid
NJ0167738Medicaid