Provider Demographics
NPI:1558440164
Name:COWAN, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:COWAN
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 1:1158 ISLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:MN
Mailing Address - Zip Code:55089-9540
Mailing Address - Country:US
Mailing Address - Phone:651-385-4148
Mailing Address - Fax:
Practice Address - Street 1:1158 ISLAND BLVD
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:MN
Practice Address - Zip Code:55089-9540
Practice Address - Country:US
Practice Address - Phone:651-385-4148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN71B72NOOtherBLUE CROSS
MN1031019OtherPREFERRED ONE
MN203T5COOtherBLE PLUS
MN5720176 00OtherMN DEPT HUMAN SERVICES
MN1031019OtherPREFERRED ONE
MN203T5COOtherBLE PLUS
MN66-05190OtherMEDICA - ROSE
MN5720176 00OtherMN DEPT HUMAN SERVICES
MN66-04850OtherMEDICA - MTKA