Basic Information
| Provider Information | |||||||||
| NPI: | 1235627282 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADAM C. COHEN PLASTIC SURGERY, LLC | ||||||||
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| OtherOrganizationName: | ADAM C. COHEN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5265 N MERIDIAN ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462082651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172548087 | ||||||||
| FaxNumber: | 3172548087 | ||||||||
| Practice Location | |||||||||
| Address1: | 7150 CLEARVISTA DR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462561695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176216262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2018 | ||||||||
| LastUpdateDate: | 04/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | COHEN | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3172548087 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 01048031A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1508819210 | 01 | NPI | OTHER |