Provider Demographics
NPI:1588936728
Name:DAVID COWAN, PHD, PC
Entity type:Organization
Organization Name:DAVID COWAN, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-745-0425
Mailing Address - Street 1:43902 WOODWARD AVE
Mailing Address - Street 2:SUITE116
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5011
Mailing Address - Country:US
Mailing Address - Phone:248-745-0425
Mailing Address - Fax:248-745-0536
Practice Address - Street 1:43902 WOODWARD AVE
Practice Address - Street 2:SUITE116
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5011
Practice Address - Country:US
Practice Address - Phone:248-745-0425
Practice Address - Fax:248-745-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005488103G00000X, 103TF0200X, 103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI037721OtherVALUE OPTIONS
MI099023OtherMANAGED HEALTH NETWORK
MI47988OtherHEALTH ALLIANCE PLAN
MI9309OtherCAPE HEALTH PLAN
MI680F348600OtherBLUE CROSS BLUE SHIELD OF MI
MI2107494OtherCIGNA
MI00836270723200OtherLIBERTY MUTUAL
MI1062699OtherINTEGRATED HEALTH PLAN
MI032531000OtherMAGELLAN
MI2119722934101OtherBEECH STREET CORP
MIP83423OtherBLUE CARE NETWORK
MI032531000OtherMAGELLAN
MI47988OtherHEALTH ALLIANCE PLAN
MI00836270723200OtherLIBERTY MUTUAL