Individual
LISA JOANNE COHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3535 W 13 MILE RD STE 248, BEAUMNOT CHRONIC DISEASE CLINIC, ROYAL OAK, MI 48073-6770
(248) 551-1515
(248) 551-1516
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
4301107741
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
440204900
—
MD
01
—
700F349850
BCBSM
MI
01
—
974398-01
CAREFIRST BC/BS
MD
01
—
S062-0425
CAREFIRST BC/BS - REGIONAL
MD
Enumeration date
12/18/2006
Last updated
10/22/2020
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