Provider Demographics
NPI:1528001922
Name:COGSWELL, STEVEN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL
Last Name:COGSWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 S BALDWIN RD STE D
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-2164
Mailing Address - Country:US
Mailing Address - Phone:248-519-2322
Mailing Address - Fax:248-494-7141
Practice Address - Street 1:4405 S BALDWIN RD STE D
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359
Practice Address - Country:US
Practice Address - Phone:248-519-2322
Practice Address - Fax:248-494-7141
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4604181Medicaid
MISC059909OtherBCBS
MISC059909OtherBCBS