Provider Demographics
NPI:1699717512
Name:COWELL, KEVIN H (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:H
Last Name:COWELL
Suffix:
Gender:M
Credentials:DO
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 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:3024 EASTON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-4208
Practice Address - Country:US
Practice Address - Phone:610-694-1000
Practice Address - Fax:610-867-7180
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016284207Q00000X
ME2199207Q00000X
PAOS010872L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0131390OtherPHP OF SW MICHIGAN
MI114701167Medicaid
ME2199OtherSTATE LICENSE NUMBER
MIKC016284OtherSTATE LICENSE NUMBER
MI0131390OtherIBA HEALTH PLANS
MI0851222234OtherBCBSM
MI4701167Medicaid
MIP09270001Medicare ID - Type Unspecified
MIKC016284OtherSTATE LICENSE NUMBER
ME2199OtherSTATE LICENSE NUMBER
MI0P09270Medicare PIN