Provider Demographics
NPI:1639590540
Name:COHEN-LEWE CHICAGO CENTER FOR OSTEOPATHIC MEDICINE
Entity Type:Organization
Organization Name:COHEN-LEWE CHICAGO CENTER FOR OSTEOPATHIC MEDICINE
Other - Org Name:CHICAGO CENTER FOR OSTEOPATHIC MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN-LEWE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-830-4866
Mailing Address - Street 1:611 DARTMOUTH LN
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3817
Mailing Address - Country:US
Mailing Address - Phone:847-830-4866
Mailing Address - Fax:
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:STE. 1818
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1903
Practice Address - Country:US
Practice Address - Phone:847-830-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130877261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty