Healthcare Provider Details

I. General information

NPI: 1386703403
Provider Name (Legal Business Name): SEID COSOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W BIG BEAVER RD SUITE 309
TROY MI
48084-4736
US

IV. Provider business mailing address

PO BOX 99160
TROY MI
48099-9160
US

V. Phone/Fax

Practice location:
  • Phone: 248-244-8700
  • Fax: 248-244-8747
Mailing address:
  • Phone: 248-244-8700
  • Fax: 248-244-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberSC057395
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberSC057395
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: