Healthcare Provider Details

I. General information

NPI: 1184647364
Provider Name (Legal Business Name): JENNIFER COHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 FARMINGTON ROAD STE TEN
WEST BLOOMFIELD MI
48322
US

IV. Provider business mailing address

6400 FARMINGTON RD STE 10
WEST BLOOMFIELD MI
48322-4462
US

V. Phone/Fax

Practice location:
  • Phone: 248-788-1200
  • Fax: 248-788-2346
Mailing address:
  • Phone: 248-788-1200
  • Fax: 248-788-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301086791
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: