Provider Demographics
NPI:1215932579
Name:COHEN, STEVEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7910 W JEFFERSON BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4159
Mailing Address - Country:US
Mailing Address - Phone:260-436-3789
Mailing Address - Fax:260-436-2703
Practice Address - Street 1:7910 W JEFFERSON BLVD
Practice Address - Street 2:STE 201
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-436-3789
Practice Address - Fax:260-436-2703
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-04-22
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Provider Licenses
StateLicense IDTaxonomies
IN01025325A208000000X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100360920Medicaid
IN100360920Medicaid