Provider Demographics
NPI:1700865771
Name:COHEN, COREY MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:MICHAEL
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 ABRAHAM FLEXNOR WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1818
Practice Address - Country:US
Practice Address - Phone:502-587-4421
Practice Address - Fax:502-361-9947
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29465207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200206830AMedicaid
KY64294655Medicaid
KY1063868OtherPASSPORT
930059279OtherRAILROAD MEDICARE
KY0514308Medicare PIN
KY64294655Medicaid