Provider Demographics
NPI:1316943442
Name:COHAN, GREGG R (MD)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:R
Last Name:COHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3045 THEODORE ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5191
Mailing Address - Country:US
Mailing Address - Phone:815-577-5223
Mailing Address - Fax:815-436-7103
Practice Address - Street 1:3045 THEODORE ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5191
Practice Address - Country:US
Practice Address - Phone:815-577-5223
Practice Address - Fax:815-436-7103
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00045417OtherRAILROAD MEDICARE
IL09919564OtherBCBS
IL09919564OtherBCBS