MEDICARE: MS. CLAUDETTE RICE COHEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant		IL

General Provider Information

NPI Number	:	1174641393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CLAUDETTE RICE COHEN PA-C

Provider Business Mailing Address
First Line	:	2505 N CENTRAL PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1107
Country	:	US
Telephone Number	:	773-342-5126
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 W CHICAGO AVE
Second Line	:	2ND FL
City	:	CHICAGO
State	:	IL
Zip	:	60651-3223
Country	:	US
Telephone Number	:	773-826-9920
Fax Number	:	773-826-9929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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