Provider Demographics
NPI:1679578520
Name:COHN, MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:COHN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:COHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PC
Mailing Address - Street 1:3804 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1081
Mailing Address - Country:US
Mailing Address - Phone:505-884-7800
Mailing Address - Fax:505-884-7931
Practice Address - Street 1:3804 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1081
Practice Address - Country:US
Practice Address - Phone:505-884-7800
Practice Address - Fax:505-884-7931
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM154213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM213ES0131XMedicaid
NMNM154OtherSTATE PODIATRY LICENSE
NM480012030OtherRAILROAD MEDICARE
NM0765490001Medicare NSC
NM2350628Medicare PIN
NMNMB2255Medicare Oscar/Certification