Healthcare Provider Details

I. General information

NPI: 1710374111
Provider Name (Legal Business Name): STEPHEN W COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 HIGHLANDS PLAZA DR E STE 220
SAINT LOUIS MO
63110-1351
US

IV. Provider business mailing address

1110 HIGHLANDS PLAZA DR E STE 220
SAINT LOUIS MO
63110-1351
US

V. Phone/Fax

Practice location:
  • Phone: 314-273-0195
  • Fax: 314-273-0190
Mailing address:
  • Phone: 314-273-0195
  • Fax: 314-273-0190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number177117
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number2019016454
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019016454
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: