Healthcare Provider Details

I. General information

NPI: 1184771461
Provider Name (Legal Business Name): JAMES WELLINGTON LOWE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 HIGH ROAD
BREMEN IN
46506
US

IV. Provider business mailing address

1583 S. MEADOW DR
WARSAW IN
46580
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-2211
  • Fax: 574-546-4312
Mailing address:
  • Phone: 574-265-6743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01035648A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: