MEDICARE: FREDERICK I COHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	13101	OK

General Provider Information

NPI Number	:	1013993120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK I COHEN M.D.

Provider Business Mailing Address
First Line	:	6600 S YALE AVE
Second Line	:	STE 1400
City	:	TULSA
State	:	OK
Zip	:	74136-3310
Country	:	US
Telephone Number	:	918-488-6001
Fax Number	:	918-488-6010

Provider Business Practice Location Address
First Line	:	3218 S 79TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-1316
Country	:	US
Telephone Number	:	918-663-6228
Fax Number	:	918-665-0925

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	02/28/2008

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