Provider Demographics
NPI:1669646618
Name:PERSONALIZED FAMILY HEALTHCARE PLLC
Entity Type:Organization
Organization Name:PERSONALIZED FAMILY HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COGSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-519-2322
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:48359-2164
Practice Address - Country:US
Practice Address - Phone:248-519-2322
Practice Address - Fax:248-494-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-19
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P23080Medicare PIN