Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301080213 | MI |
NPI | 1093756298 |
---|---|
Provider Name | Dr. Robert Cohen |
First Address | Royal Oak, MI 48068-0100 |
Second Address | Southfield, MI 48075-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 28/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104776963 | (05) | MI |
104794415 | (05) | MI |
I47496 | (02) | MI |
RC080213 | BC/BS OF MICHIGAN (01) | MI |