Healthcare Provider Details

I. General information

NPI: 1710967658
Provider Name (Legal Business Name): DAVID P GOWMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28080 GRAND RIVER AVE STE 306N
FARMINGTON HILLS MI
48336-5966
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 947-521-4771
  • Fax: 248-473-4772
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5101010938
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: