Provider Demographics
NPI:1689792228
Name:COWSILL, MEGAN JANINE (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:JANINE
Last Name:COWSILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25511 LITTLE MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3372
Mailing Address - Country:US
Mailing Address - Phone:586-774-2020
Mailing Address - Fax:
Practice Address - Street 1:25511 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3372
Practice Address - Country:US
Practice Address - Phone:586-774-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015591207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1855013055OtherBLUE CROSS BLUE SHIELD
MI5199342-11Medicaid
MIN93750006Medicare PIN