Individual
JOEL N COHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 SUNNYBROOK CT, SOUTH BEND, IN 46637-3437
(574) 243-3100
Mailing address
111 SUNNYBROOK CT, SOUTH BEND, IN 46637-3437
(574) 243-3100
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
01055519A
IN
2085R0001X
Radiation Oncology Physician
01055519A
IN
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000485522
ANTHEM PROVIDER NUMBER
IN
05
—
200358430
—
IN
01
—
375079
PHCS PID NUMBER
IN
01
—
P00732885
RR MEDICARE
IN
Enumeration date
05/26/2006
Last updated
02/28/2018
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