Provider Demographics
NPI:1356332829
Name:COWARDIN, WILLIAM L (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:COWARDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SIXTH AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:58303
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 SIXTH AVE NORTH
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:58303
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN30744207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
108497OtherU CARE
2114037OtherFIRST HEALTH PLAN
30744OtherMN LICENSE NUMBER
05201999OtherMMSI
600905OtherARAZ GROUP AMERICAS PPO
6D058COOtherBLUE CROSS BLUE SHIELD
108083100OtherMEDICAL ASSISTANCE
3129213OtherMEDICAL HEALTH PLANS
986004OtherPREFERRED ONE
986004OtherPREFERRED ONE
600905OtherARAZ GROUP AMERICAS PPO
30744OtherMN LICENSE NUMBER
3129213OtherMEDICAL HEALTH PLANS
CU0204Medicare ID - Type UnspecifiedRR