Provider Demographics
NPI:1194785485
Name:COHEN, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3700 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:KS
Mailing Address - Zip Code:66208-1710
Mailing Address - Country:US
Mailing Address - Phone:786-281-3827
Mailing Address - Fax:
Practice Address - Street 1:8656 N AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-2558
Practice Address - Country:US
Practice Address - Phone:816-584-8100
Practice Address - Fax:816-584-8106
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83523207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO30690048OtherBLUE CROSS
FL270210000Medicaid
FL48882OtherBLUE CROSS
FL48882OtherBLUE CROSS
X65B785Medicare PIN