Healthcare Provider Details

I. General information

NPI: 1952231532
Provider Name (Legal Business Name): SAM BRADLEY COHN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 N SHERIDAN RD APT 5507
CHICAGO IL
60640-7416
US

IV. Provider business mailing address

5415 N SHERIDAN RD APT 5507
CHICAGO IL
60640-7416
US

V. Phone/Fax

Practice location:
  • Phone: 630-200-5488
  • Fax:
Mailing address:
  • Phone: 630-200-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041505310
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: