Provider Demographics
NPI:1669447348
Name:COHEN, GREG S (MD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:S
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE 1525
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-695-4452
Mailing Address - Fax:312-695-4453
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 1525
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-695-4452
Practice Address - Fax:312-695-4453
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036104546207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104546Medicaid
H64348Medicare UPIN