Basic Information
| Provider Information | |||||||||
| NPI: | 1831127083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COWAN | ||||||||
| FirstName: | MIA | ||||||||
| MiddleName: | TERESE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2807 GREYSTONE COMMERCIAL BLVD | ||||||||
| Address2: | UNIT 38 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352429601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059951009 | ||||||||
| FaxNumber: | 2059951049 | ||||||||
| Practice Location | |||||||||
| Address1: | 2807 GREYSTONE COMMERCIAL BLVD | ||||||||
| Address2: | UNIT 38 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352429601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059951009 | ||||||||
| FaxNumber: | 2059951049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 27416 | AL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1831127083 | 05 | AL | MEDICAID | 27416 | 01 | AL | MEDICAL LICENSE | OTHER |