Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME0013677 | FL |
NPI | 1013909951 |
---|---|
Provider Name | Michael D Kohen |
First Address | Daytona Beach, FL 32114-1603 |
Second Address | Daytona Beach, FL 32114-1603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 12/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053943100 | (05) | FL |
64299 | BLUE CROSS/BLUE SHIELD (01) | FL |
D57628 | (02) |