Healthcare Provider Details

I. General information

NPI: 1033405469
Provider Name (Legal Business Name): ANN PARKIN-COHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN PARKIN M.D.

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3422 COURT ST
PEKIN IL
61554-6235
US

IV. Provider business mailing address

2214 N UNIVERSITY ST
PEORIA IL
61604-3221
US

V. Phone/Fax

Practice location:
  • Phone: 309-680-7600
  • Fax: 309-495-6698
Mailing address:
  • Phone: 309-680-7669
  • Fax: 309-681-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2014013918
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2011016862
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036142780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: