Individual
BRIAN COHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2127 SW JEFFERSON AVE, PEORIA, IL 61605-3645
(309) 674-4812
Mailing address
5100 RELIABLE PKWY, CHICAGO, IL 60686-0001
(309) 672-4809
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008412
HEALTH ALLIANCE
IL
05
—
0360648742
—
IL
01
—
663598
HEALTHLINK
IL
01
—
7215059
BCBS PPO
IL
01
—
IL01R9
JOHN DEERE
IL
01
—
P00151868
RAILROAD MEDICARE
IL
Enumeration date
07/27/2006
Last updated
07/08/2007
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