Healthcare Provider Details

I. General information

NPI: 1750337911
Provider Name (Legal Business Name): JOEL N COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SUNNYBROOK CT
SOUTH BEND IN
46637-3437
US

IV. Provider business mailing address

111 SUNNYBROOK CT
SOUTH BEND IN
46637-3437
US

V. Phone/Fax

Practice location:
  • Phone: 574-243-3100
  • Fax:
Mailing address:
  • Phone: 574-243-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number01055519A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01055519A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: