Provider Demographics
NPI:1184681421
Name:COWART, MICHAEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:COWART
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 1:6617 HERITAGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8750
Mailing Address - Country:US
Mailing Address - Phone:972-475-3030
Mailing Address - Fax:972-475-0707
Practice Address - Street 1:6617 HERITAGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8750
Practice Address - Country:US
Practice Address - Phone:972-475-3030
Practice Address - Fax:972-475-0707
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH-4254207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136719502Medicaid
TXC14822Medicare UPIN
TX136719502Medicaid