MEDICARE: DR. DAVID MICHAEL COWAN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301005488	MI
2	103G00000X	Clinical Neuropsychologist	6301005488	MI
3	103TC0700X	Clinical Psychologist	6301005488	MI
4	103TF0200X	Forensic Psychologist	6301005488	MI
5	103TH0004X	Health Psychologist	6301005488	MI
6	103TR0400X	Rehabilitation Psychologist	6301005488	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BM630101	OTHER		MCARE
2	2107494	OTHER		CIGNA HEALTHCARE
3	037721	OTHER		VALUE OPTIONS
4	680F348600	OTHER	MI	BLUE CROSS
5	9309	OTHER		CAPE HEALTH PLAN
6	1062699	OTHER		INTEGRATED HEALTH PLAN
7	P83423	OTHER		BLUE CARE NETWORK BCN
8	032531000	OTHER		MAGELLAN
9	099023	OTHER		MANAGED HEALTH NETWORK
10	1235334939	OTHER	MI	GROUP NPI
11	2119722934101	OTHER		BEECH STREET CORP
12	47988	OTHER		HEALTH ALLIANCE PLAN HAP

General Provider Information

NPI Number	:	1124106398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MICHAEL COWAN PHD

Provider Business Mailing Address
First Line	:	PO BOX 430022
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48343-0022
Country	:	US
Telephone Number	:	248-745-0425
Fax Number	:	248-745-0536

Provider Business Practice Location Address
First Line	:	43902 WOODWARD AVENUE
Second Line	:	SUITE 116
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5021
Country	:	US
Telephone Number	:	248-745-0425
Fax Number	:	248-745-0536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	04/11/2016

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