Provider Demographics
NPI:1316073463
Name:COHOON, TRACY SUZZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:SUZZANNE
Last Name:COHOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:SUZZANNE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3950 KRESGE WAY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4637
Mailing Address - Country:US
Mailing Address - Phone:502-895-8911
Mailing Address - Fax:502-895-8977
Practice Address - Street 1:3950 KRESGE WAY
Practice Address - Street 2:SUITE 308
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4637
Practice Address - Country:US
Practice Address - Phone:502-895-8911
Practice Address - Fax:502-895-8977
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000919568OtherANTHEM
KY000000592728OtherBCBS
KY7100068690Medicaid
KY7100068690Medicaid