Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301114405 | MI |
N | 111NI0900X | Internist | 4301114405 | MI |
N | 207R00000X | Internist | A132198 | CA |
N | 111NI0900X | Internist | A132198 | CA |
N | 207RC0200X | Critical Care Medicine | 4301114405 | MI |
N | 207RC0200X | Critical Care Medicine | A132198 | CA |
Y | 207RP1001X | Pulmonary Disease | 4301114405 | MI |
N | 207RP1001X | Pulmonary Disease | A132198 | CA |
NPI | 1003173667 |
---|---|
Provider Name | Avi Cohen |
First Address | Detroit, MI 48202-2608 |
Second Address | Detroit, MI 48202-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 02/12/2019 |