Provider Demographics
NPI:1750337911
Name:COHEN, JOEL N (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:N
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 1:111 SUNNYBROOK CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-3437
Mailing Address - Country:US
Mailing Address - Phone:574-243-3100
Mailing Address - Fax:
Practice Address - Street 1:111 SUNNYBROOK CT
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-3437
Practice Address - Country:US
Practice Address - Phone:574-243-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055519A207RH0002X, 2085R0001X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000485522OtherANTHEM PROVIDER NUMBER
IN375079OtherPHCS PID NUMBER
IN200358430Medicaid
INP00732885OtherRR MEDICARE
IN200358430Medicaid
IN815450FFMedicare PIN
IN216950AAMedicare PIN
INP00732885OtherRR MEDICARE