Healthcare Provider Details

I. General information

NPI: 1679772446
Provider Name (Legal Business Name): MICHAEL D. KOHEN, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-1603
US

IV. Provider business mailing address

709 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-1603
US

V. Phone/Fax

Practice location:
  • Phone: 386-252-1632
  • Fax: 386-257-5526
Mailing address:
  • Phone: 386-252-1632
  • Fax: 386-257-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VINICIUS COSTA DINIZ DOMINGUES
Title or Position: PRESIDENT
Credential:
Phone: 386-252-1632