Healthcare Provider Details

I. General information

NPI: 1366174252
Provider Name (Legal Business Name): ALEXIS RAE BOWMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/23/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 SIMPSON AVE
ELKHART IN
46516-4666
US

IV. Provider business mailing address

236 SIMPSON AVE
ELKHART IN
46516-4666
US

V. Phone/Fax

Practice location:
  • Phone: 574-293-0052
  • Fax:
Mailing address:
  • Phone: 574-293-0052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351050099
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: