Michael R Cohen, DO, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

5101014034 Issued in MI

Legal business name

MICHAEL R COHEN, DO, PLLC

Doing business as

Great Lakes Dermatology

Practice address

39475 Lewis Dr
Suite 150
Novi, MI 48377-2981

Phone

(248) 324-2222

Fax

(248) 324-0009

NPI assigned

Nov 9, 2007

Last updated

Jun 21, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Randy Cohen, D.O.

Title

Physician/Owner

Phone

(248) 259-7733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Great Lakes Dermatology Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1225218076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6773 OYSTER CV",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483232050",
            "telephone_number": "248-259-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39475 LEWIS DR",
            "address_2": "SUITE 150",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483772981",
            "telephone_number": "248-324-2222",
            "fax_number": "248-324-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL R COHEN, DO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-09",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "RANDY",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "248-259-7733",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "5101014034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD CARRIER",
            "identifier": "DE3321",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great Lakes Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashley Micakovic
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• Michael a Roth MD PC
• Michael J. Jacobs, M. D. P.C.
• Michael P. Burk, D.P.M., PLLC
• Michael S Finn PC
• Nichole Michael
• Jenny R Michaels, MD MPH
• Kelsey Michals, PT, DPT
• Blaire E Michelin

• Dermatology Physician in Novi, MI
• Providers in Novi, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.