Healthcare Provider Details

I. General information

NPI: 1669572400
Provider Name (Legal Business Name): MITCHELL BRADLEY COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 N UNIVERSITY DR STE A
PEMBROKE PINES FL
33024-3611
US

IV. Provider business mailing address

3700 WASHINGTON ST STE 500A
HOLLYWOOD FL
33021-8256
US

V. Phone/Fax

Practice location:
  • Phone: 954-963-2151
  • Fax: 954-966-6629
Mailing address:
  • Phone: 954-989-4700
  • Fax: 954-966-6629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME69057
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME69057
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME69057
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: