Provider Demographics
NPI:1992005821
Name:DIANA L. COHEN, D.O., P.C.
Entity Type:Organization
Organization Name:DIANA L. COHEN, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-656-7290
Mailing Address - Street 1:1240 S LAPEER RD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1470
Mailing Address - Country:US
Mailing Address - Phone:248-656-7290
Mailing Address - Fax:
Practice Address - Street 1:1240 S LAPEER RD
Practice Address - Street 2:SUITE 101B
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1470
Practice Address - Country:US
Practice Address - Phone:248-656-7290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010676207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N34440Medicare PIN