Healthcare Provider Details

I. General information

NPI: 1174785182
Provider Name (Legal Business Name): MATTHEW ALLEN BOWEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 FARR RD
NORTON SHORES MI
49444-9738
US

IV. Provider business mailing address

1450 FARR RD
NORTON SHORES MI
49444-9738
US

V. Phone/Fax

Practice location:
  • Phone: 231-739-9095
  • Fax: 231-739-6439
Mailing address:
  • Phone: 231-739-9095
  • Fax: 231-739-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number4301102283
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number4301102283
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301102283
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: