Provider Demographics
NPI:1104083179
Name:COHN, MITCHELL AARON (DO)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:AARON
Last Name:COHN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3700 52ND ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9637
Mailing Address - Country:US
Mailing Address - Phone:616-656-3700
Mailing Address - Fax:616-656-3701
Practice Address - Street 1:1416 W MILHAM AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-2245
Practice Address - Country:US
Practice Address - Phone:269-290-7700
Practice Address - Fax:888-807-1562
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012527208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5330177OtherBLUE CROSS/BLUE SHIELD
MI01-00603OtherPHYSICIANS HEALTH PLAN OF MID MICHIGAN
MI5330177OtherBLUE CROSS/BLUE SHIELD
MIOM54690Medicare PIN