Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 2005-00695 | NC |
NPI | 1316057821 |
---|---|
Provider Name | Dr. Michael Robert Cohen |
First Address | Savannah, GA 31416-2549 |
Second Address | Pooler, GA 31322-4052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 25/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
065646 | GA MEDICAL LICENSE (01) | GA |
144AY | BCBSNC (01) | NC |
194192 | MEDCOST (01) | NC |
2834791 | CIGNA HEALTHCARE (01) | NC |
5905703 | (05) | NC |
64973 | (02) | FL |