MEDICARE: MICHAEL RANDY COHEN D.O.

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	207N00000X	Dermatology Physician	OS9060	FL

General Provider Information

NPI Number	:	1568458115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL RANDY COHEN D.O.

Provider Business Mailing Address
First Line	:	900 VILLAGE SQUARE XING STE 290
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4552
Country	:	US
Telephone Number	:	239-232-1180
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 N COLLIER BLVD STE 303
Second Line	:
City	:	MARCO ISLAND
State	:	FL
Zip	:	34145-2716
Country	:	US
Telephone Number	:	239-642-3337
Fax Number	:	239-642-3053

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/12/2022

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