MEDICARE: GLENN D. COHEN, MD INC.

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	174400000X	Specialist	A55543	CA

General Provider Information

NPI Number	:	1083896096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENN D. COHEN, MD INC.

Provider Business Mailing Address
First Line	:	1014 S WESTLAKE BLVD
Second Line	:	SUITE 14 PMB 228
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-3108
Country	:	US
Telephone Number	:	805-370-6877
Fax Number	:	805-777-7411

Provider Business Practice Location Address
First Line	:	696 HAMPSHIRE RD
Second Line	:	SUITE 180
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-2635
Country	:	US
Telephone Number	:	805-370-6877
Fax Number	:	805-777-7411

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GLENN D COHEN
Credential	:	MD
Telephone Number	:	805-370-6877

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	06/26/2008

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