Provider Demographics
NPI:1679667620
Name:COHEN PODIATRY PC
Entity Type:Organization
Organization Name:COHEN PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-821-3338
Mailing Address - Street 1:7633 E JEFFERSON
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214
Mailing Address - Country:US
Mailing Address - Phone:313-821-3338
Mailing Address - Fax:313-823-5363
Practice Address - Street 1:7633 E JEFFERSON
Practice Address - Street 2:SUITE 250
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214
Practice Address - Country:US
Practice Address - Phone:313-821-3338
Practice Address - Fax:313-823-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISC001139213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1582680Medicaid
MI480H227650OtherBCBSM GROUP PIN
MIT51156Medicare UPIN
MI0P26350Medicare ID - Type UnspecifiedGROUP MEDICARE
MI1088610001Medicare NSC
MIT97286Medicare UPIN
MIT34369Medicare UPIN