Provider Demographics
NPI:1386703403
Name:COSOVIC, SEID (MD)
Entity type:Individual
Prefix:DR
First Name:SEID
Middle Name:
Last Name:COSOVIC
Suffix:
Gender:M
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:PO BOX 99160
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-9160
Mailing Address - Country:US
Mailing Address - Phone:248-244-8700
Mailing Address - Fax:248-244-8747
Practice Address - Street 1:888 W BIG BEAVER RD
Practice Address - Street 2:SUITE 309
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4736
Practice Address - Country:US
Practice Address - Phone:248-244-8700
Practice Address - Fax:248-244-8747
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISC057395207QS0010X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0806335011OtherBCBS
MI3510124Medicaid
MI0806335011OtherBCBS
MI0N78860Medicare ID - Type Unspecified