1588936728 NPI number — DAVID COWAN, PHD, PC

Table of content: BRENDAN KEEGAN (NPI 1346732344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588936728 NPI number — DAVID COWAN, PHD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID COWAN, PHD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1588936728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43902 WOODWARD AVE
Provider Second Line Business Mailing Address:
SUITE116
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48302-5011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-745-0425
Provider Business Mailing Address Fax Number:
248-745-0536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43902 WOODWARD AVE
Provider Second Line Business Practice Location Address:
SUITE116
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48302-5011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-745-0425
Provider Business Practice Location Address Fax Number:
248-745-0536
Provider Enumeration Date:
02/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
COWAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-745-0425

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  6301005488 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 6301005488 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TF0200X , with the licence number: 6301005488 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TH0004X , with the licence number: 6301005488 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 037721 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 099023 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 47988 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 9309 . This is a "CAPE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 680F348600 . This is a "BLUE CROSS BLUE SHIELD OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2107494 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 00836270723200 . This is a "LIBERTY MUTUAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1062699 . This is a "INTEGRATED HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 032531000 . This is a "MAGELLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2119722934101 . This is a "BEECH STREET CORP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P83423 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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