Provider Demographics
NPI:1235334939
Name:DAVID M. COWAN, PHD, PLLC
Entity Type:Organization
Organization Name:DAVID M. COWAN, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:SUITE 116
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:SUITE 116
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:2007-06-20
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005488103G00000X, 103T00000X, 103TC0700X, 103TF0200X, 103TH0004X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI099023OtherUNITED HEALTHCARE
MI2107494OtherCIGNA
MI126823OtherCARE CHOICES
MI2119722934101OtherBEECH STREET
MI037721OtherVALUE OPTIONS
MIBM630101OtherMCARE
MIP83423OtherBLUE CARE NETWORK
MI099023OtherMHN
MI1062699OtherIHP
MI47988OtherHEALTH ALLIANCE PLAN
MI9309OtherCAPE HEALTH PLAN
MI00836270723200OtherLIBERTY MUTUAL
MI47988OtherHEALTH ALLIANCE PLAN
MIBM630101OtherMCARE