MEDICARE: DR. TED COHEN DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	DPM9301	NV

General Provider Information

NPI Number	:	1619014743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TED COHEN DPM

Provider Business Mailing Address
First Line	:	501 S RANCHO DR
Second Line	:	I-61
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4828
Country	:	US
Telephone Number	:	702-387-8777
Fax Number	:	702-387-8722

Provider Business Practice Location Address
First Line	:	501 S RANCHO DR
Second Line	:	I-61
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4828
Country	:	US
Telephone Number	:	702-387-8777
Fax Number	:	702-387-8722

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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Practice Location Address:

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Practice Location Address:

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Directions to “ DR. TED COHEN DPM” Practice Location

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