Provider Demographics
NPI:1700999588
Name:COHEN, LAWRENCE MILTON (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MILTON
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 1:5839 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-6560
Mailing Address - Country:US
Mailing Address - Phone:317-353-9777
Mailing Address - Fax:317-357-6922
Practice Address - Street 1:5839 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-6560
Practice Address - Country:US
Practice Address - Phone:317-353-9777
Practice Address - Fax:317-357-6922
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027020A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10062370AMedicaid
IN10062370AMedicaid
INM147140030Medicare PIN
IN10062370AMedicaid