Provider Demographics
NPI:1124106398
Name:COWAN, DAVID MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:COWAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430022
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48343-0022
Mailing Address - Country:US
Mailing Address - Phone:248-745-0425
Mailing Address - Fax:248-745-0536
Practice Address - Street 1:43902 WOODWARD AVENUE
Practice Address - Street 2:SUITE 116
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5021
Practice Address - Country:US
Practice Address - Phone:248-745-0425
Practice Address - Fax:248-745-0536
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005488103T00000X, 103G00000X, 103TC0700X, 103TF0200X, 103TH0004X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
BM630101OtherMCARE
2107494OtherCIGNA HEALTHCARE
037721OtherVALUE OPTIONS
MI680F348600OtherBLUE CROSS
9309OtherCAPE HEALTH PLAN
1062699OtherINTEGRATED HEALTH PLAN
P83423OtherBLUE CARE NETWORK BCN
032531000OtherMAGELLAN
099023OtherMANAGED HEALTH NETWORK
MI1235334939OtherGROUP NPI
2119722934101OtherBEECH STREET CORP
47988OtherHEALTH ALLIANCE PLAN HAP
47988OtherHEALTH ALLIANCE PLAN HAP
9309OtherCAPE HEALTH PLAN
R67221Medicare UPIN