Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | IL |
NPI | 1063434231 |
---|---|
Provider Name | Lewis Michael Cohen |
First Address | Evanston, IL 60201-1718 |
Second Address | Evanston, IL 60201-1777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 27/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1620385 | BCBS PPO (01) | IL |
C38993 | (02) |