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General NPI Number Information
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NPI Number | 1376547711
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Entity Type | Individual
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Provider Name | IRWIN RANDELL COHEN
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 4006 DUTCHMANS LN SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40207-4704
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Country | US
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Telephone | 502-873-7517
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Fax |
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Provider Business Mailing Address
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Address Line | 4307 GLENARM RD
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City | CRESTWOOD
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State | KY
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Zip | 40014-9586
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Country | US
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Telephone | 502-241-2892
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 29908
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2011000734
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 29908
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License Number State | KY
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