1124106398 NPI number — DR. DAVID MICHAEL COWAN PHD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124106398 NPI number — DR. DAVID MICHAEL COWAN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COWAN
Provider First Name:
DAVID
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1124106398
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 430022
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48343-0022
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 AVENUE
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48302-5021
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:
11/02/2006

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: 103T00000X , 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: 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" .
  • Taxonomy code: 103TR0400X , 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: BM630101 . This is a "MCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2107494 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 037721 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 680F348600 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 9309 . This is a "CAPE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1062699 . This is a "INTEGRATED HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P83423 . This is a "BLUE CARE NETWORK BCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 032531000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 099023 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1235334939 . This is a "GROUP NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2119722934101 . This is a "BEECH STREET CORP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47988 . This is a "HEALTH ALLIANCE PLAN HAP" identifier . This identifiers is of the category "OTHER".




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