MEDICARE: JAMES ALLEN BOWEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1225852536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ALLEN BOWEN

Provider Business Mailing Address
First Line	:	1203 GILMAN ST
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-3075
Country	:	US
Telephone Number	:	734-620-1842
Fax Number	:

Provider Business Practice Location Address
First Line	:	15400 GRAND RIVER AVE FL 2
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-4124
Country	:	US
Telephone Number	:	313-236-8027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	11/13/2024

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