Provider Demographics
NPI:1316057821
Name:COHEN, MICHAEL ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15849
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2549
Mailing Address - Country:US
Mailing Address - Phone:912-748-2280
Mailing Address - Fax:912-748-4988
Practice Address - Street 1:1000 TOWNE CENTER BLVD
Practice Address - Street 2:SUITE 701
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4052
Practice Address - Country:US
Practice Address - Phone:912-748-2280
Practice Address - Fax:912-748-4988
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00695207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC194192OtherMEDCOST
GA065646OtherGA MEDICAL LICENSE
NC144AYOtherBCBSNC
NC2834791OtherCIGNA HEALTHCARE
NC5905703Medicaid
NC5905703Medicaid
NC2834791OtherCIGNA HEALTHCARE