1396747887 NPI number — DR. HILLARD KENNITH COHEN MD

Table of content: DR. HILLARD KENNITH COHEN MD (NPI 1396747887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396747887 NPI number — DR. HILLARD KENNITH COHEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHEN
Provider First Name:
HILLARD
Provider Middle Name:
KENNITH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396747887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 NORTHWEST PLZ
Provider Second Line Business Mailing Address:
SUITE 417
Provider Business Mailing Address City Name:
SAINT ANN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63074-2209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-739-9313
Provider Business Mailing Address Fax Number:
314-739-9322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 NORTHWEST PLZ
Provider Second Line Business Practice Location Address:
SUITE 417
Provider Business Practice Location Address City Name:
SAINT ANN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63074-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-739-9313
Provider Business Practice Location Address Fax Number:
314-739-9322
Provider Enumeration Date:
08/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MOR2749 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)