Organization
MICHAEL R COHEN, DO, PLLC
Active
Other names
Great Lakes Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RANDY COHEN D.O. (PHYSICIAN/OWNER)
(248) 259-7733
Entity
Organization
Contact information
Practice address
39475 LEWIS DR, SUITE 150, NOVI, MI 48377-2981
(248) 324-2222
(248) 324-0009
Mailing address
6773 OYSTER CV, WEST BLOOMFIELD, MI 48323-2050
(248) 259-7733
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
5101014034
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE3321
MEDICARE RAILROAD CARRIER
MI
Enumeration date
11/09/2007
Last updated
06/21/2021
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