Provider Demographics
NPI:1649239740
Name:COHEN, ROBERT I (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:369
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:773-271-0807
Mailing Address - Fax:484-723-7350
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:369
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:773-271-0807
Practice Address - Fax:484-723-7350
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002871213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016002871Medicaid
IL016002871Medicaid
IL931280Medicare PIN