Healthcare Provider Details

I. General information

NPI: 1154631786
Provider Name (Legal Business Name): MICHAEL B COHEN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BRICKELL AVE
MIAMI FL
33131-2576
US

IV. Provider business mailing address

500 BRICKELL AVE
MIAMI FL
33131-2576
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-8187
  • Fax: 305-279-8194
Mailing address:
  • Phone: 305-279-8187
  • Fax: 305-279-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME99528
License Number StateFL

VIII. Authorized Official

Name: MICHAEL B COHEN
Title or Position: PRESIDENT
Credential: MD
Phone: 305-279-8187