Healthcare Provider Details

I. General information

NPI: 1588082051
Provider Name (Legal Business Name): JOHN THOMAS OWINGS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25373 VAN DYKE AVE
CENTER LINE MI
48015-1425
US

IV. Provider business mailing address

7430 2ND AVE SUITE 210
DETROIT MI
48202-2739
US

V. Phone/Fax

Practice location:
  • Phone: 586-261-2500
  • Fax:
Mailing address:
  • Phone: 313-748-4200
  • Fax: 313-748-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL2359348
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberL163015
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: