Provider Demographics
NPI:1770658601
Name:COHEN, MICHAEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
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 1:16811 BURKE STREET
Mailing Address - Street 2:STE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118
Mailing Address - Country:US
Mailing Address - Phone:402-573-7337
Mailing Address - Fax:
Practice Address - Street 1:16811 BURKE STREET
Practice Address - Street 2:STE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118
Practice Address - Country:US
Practice Address - Phone:402-573-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21428208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1200583Medicaid
NE1201452Medicaid
NE34048OtherBCBS OF NE
NE35058OtherMIDLANDS CHOICE
NE1200580Medicaid
NE1200582Medicaid
NE1200407Medicaid
NE1201171Medicaid
NE1201448Medicaid
IA0538595Medicaid
IA1538595Medicaid