Healthcare Provider Details

I. General information

NPI: 1528233665
Provider Name (Legal Business Name): MICHAEL COHEN-WOLKOWIEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ERWIN RD
DURHAM NC
27705-3941
US

IV. Provider business mailing address

2100 ERWIN RD
DURHAM NC
27705-3941
US

V. Phone/Fax

Practice location:
  • Phone: 919-970-8231
  • Fax:
Mailing address:
  • Phone: 919-970-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number2009-01773
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number132697
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: