Individual
MR. MICAH DAN COWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
12222 MERIT DR STE 600, DALLAS, TX 75251-3294
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
652282
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP112934
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166647103
—
TX
01
—
166647106
MEDICAID CSHCN
TX
01
—
85431U
BCBS
TX
01
—
89161U
BCBS
—
Enumeration date
12/29/2005
Last updated
07/15/2022
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