MEDICARE: DONALD D MCGOWAN, DPM

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1932389244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD D MCGOWAN, DPM

Provider Business Mailing Address
First Line	:	3015 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2347
Country	:	US
Telephone Number	:	574-288-8200
Fax Number	:	574-288-8226

Provider Business Practice Location Address
First Line	:	3015 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2347
Country	:	US
Telephone Number	:	574-288-8200
Fax Number	:	574-288-8226

Authorized Official
Title or Position	:	OWNER
Name	:	DONALD D MCGOWAN
Credential	:
Telephone Number	:	574-288-8200

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	07/22/2010

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