Provider Demographics
NPI:1902845290
Name:COHEN, ANDREW H (DPM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-4025
Mailing Address - Country:US
Mailing Address - Phone:989-790-8009
Mailing Address - Fax:
Practice Address - Street 1:4224 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-4025
Practice Address - Country:US
Practice Address - Phone:989-790-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001545213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3012337Medicaid
MI0N93370001Medicare PIN
MI3012337Medicaid
MI480016064Medicare PIN
MI1117740001Medicare NSC