Healthcare Provider Details

I. General information

NPI: 1629187810
Provider Name (Legal Business Name): JULIE M BOWSER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5973 BEATRICE DRIVE
KALAMAZOO MI
49009
US

IV. Provider business mailing address

601 JOHN ST # 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-286-7110
  • Fax: 269-286-7111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002819
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: