Provider Demographics
NPI:1669572400
Name:COHEN, MITCHELL BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:BRADLEY
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 1:3700 WASHINGTON ST STE 500A
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8256
Mailing Address - Country:US
Mailing Address - Phone:954-989-4700
Mailing Address - Fax:954-966-6629
Practice Address - Street 1:2213 N UNIVERSITY DR STE A
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3611
Practice Address - Country:US
Practice Address - Phone:954-963-2151
Practice Address - Fax:954-966-6629
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69057207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL236328OtherAVMED
FL250842700Medicaid
FL25119OtherNEIGHBORHOOD HEALTH
FLBC&BSOther28918
FLBA500OtherGROUP MEDICARE
FL5599519OtherAETNA
FLF99107Medicare UPIN
K1532Medicare ID - Type Unspecified