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General NPI Number Information
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NPI Number | 1669646618
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Entity Type | Organization
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Legal Business Name | PERSONALIZED FAMILY HEALTHCARE PLLC
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Dates
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Enumeration Date | 04/19/2008
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 4405 S BALDWIN RD STE D
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City | LAKE ORION
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State | MI
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Zip | 48359-2164
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Country | US
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Telephone | 248-519-2322
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Fax | 248-494-7141
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Provider Business Mailing Address
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Address Line | 4405 S BALDWIN RD STE D
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City | LAKE ORION
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State | MI
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Zip | 48359-2164
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Country | US
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Telephone | 248-519-2322
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Fax | 248-494-7141
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN P COGSWELL
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Credential | M.D.
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Telephone | 248-519-2322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301059909
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License Number State | MI
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