Healthcare Provider Details

I. General information

NPI: 1801966155
Provider Name (Legal Business Name): MICHELL ANNETTE COHN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12324 SAINT ANDREWS DR
OKLAHOMA CITY OK
73120-8604
US

IV. Provider business mailing address

14709 LAMPLIGHT LN
EDMOND OK
73013-1591
US

V. Phone/Fax

Practice location:
  • Phone: 405-607-1333
  • Fax: 405-607-1330
Mailing address:
  • Phone: 405-922-1054
  • Fax: 405-692-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number3843
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: