Individual
CLARISSA C COWLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5130 COOLIDGE HIGHWAY, ROYAL OAK, MI 48073
(248) 288-9500
(248) 288-0044
Mailing address
30625 WOODGATE, SOUTHFIELD, MI 48076
(248) 433-1247
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M143041361
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356359202
—
MI
01
—
1604702141
BCBS IND
MI
01
—
700H231390
BCBS GROUP NUMBER
MI
Enumeration date
08/04/2006
Last updated
07/08/2011
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