Provider Demographics
NPI:1003870817
Name:COHEN, CARRIE E (DO)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:E
Last Name:COHEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 N EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4937
Mailing Address - Country:US
Mailing Address - Phone:316-858-1111
Mailing Address - Fax:316-946-5293
Practice Address - Street 1:775 N EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4937
Practice Address - Country:US
Practice Address - Phone:316-858-1111
Practice Address - Fax:316-946-5293
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0530647208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200265810EMedicaid
KS105306OtherBLUE CROSS BLUE SHIELD
KS105306Medicare ID - Type Unspecified
KSI10516Medicare UPIN