Provider Demographics
NPI:1164408548
Name:COSMIC, MAXWELL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:S
Last Name:COSMIC
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 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-7900
Mailing Address - Fax:515-643-7901
Practice Address - Street 1:411 LAUREL ST STE A120
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3027
Practice Address - Country:US
Practice Address - Phone:515-643-7900
Practice Address - Fax:515-643-7901
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34992207RC0200X, 207RP1001X
IAMD-34992207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA239198OtherMIDLAND'S CHOICE
IA165260OtherCOVENTRY
IAIA0139OtherUHC OF THE RIVER VALLEY
IA0286559Medicaid
IA1907221OtherUNITED HEALTHCARE
IA34116OtherWELLMARK
IAI8410Medicare ID - Type Unspecified
IA239198OtherMIDLAND'S CHOICE