Healthcare Provider Details

I. General information

NPI: 1184134322
Provider Name (Legal Business Name): MR. BRYAN LEIGHTON OWENS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E ELM AVE
MONROE MI
48162-2600
US

IV. Provider business mailing address

214 E ELM AVE STE 111
MONROE MI
48162-2678
US

V. Phone/Fax

Practice location:
  • Phone: 734-241-4080
  • Fax: 734-241-4798
Mailing address:
  • Phone: 734-241-4080
  • Fax: 734-241-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501003274
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: