Healthcare Provider Details

I. General information

NPI: 1164550372
Provider Name (Legal Business Name): KENT CALVIN BOWDEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 S CARMEL ST
CADILLAC MI
49601
US

IV. Provider business mailing address

927 S CARMEL ST
CADILLAC MI
49601-2547
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-3876
  • Fax: 231-775-1115
Mailing address:
  • Phone: 231-876-3876
  • Fax: 231-775-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101016414
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: