Healthcare Provider Details

I. General information

NPI: 1386902948
Provider Name (Legal Business Name): VANESSA SCOWDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W SHIAWASSEE AVE
FENTON MI
48430-2093
US

IV. Provider business mailing address

202 W SHIAWASSEE AVE STE 104
FENTON MI
48430-2093
US

V. Phone/Fax

Practice location:
  • Phone: 248-266-0473
  • Fax: 810-777-5963
Mailing address:
  • Phone: 248-266-0473
  • Fax: 810-777-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301107192
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: