Provider Demographics
NPI:1902921067
Name:COHEN, KIMMERLE CHRISHINA (MD)
Entity Type:Individual
Prefix:
First Name:KIMMERLE
Middle Name:CHRISHINA
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 N FLAGLER DR STE 4900
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3410
Mailing Address - Country:US
Mailing Address - Phone:561-835-3396
Mailing Address - Fax:561-804-4334
Practice Address - Street 1:1411 N FLAGLER DR STE 4900
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3410
Practice Address - Country:US
Practice Address - Phone:561-835-3396
Practice Address - Fax:561-804-4334
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL 29019208600000X
FLME1133344208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009486900Medicaid
FLHP606ZMedicare PIN