Healthcare Provider Details

I. General information

NPI: 1255316691
Provider Name (Legal Business Name): MARK BOWERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEMLOCK
TAWAS CITY MI
48763
US

IV. Provider business mailing address

PO BOX 779
TAWAS CITY MI
48764-0779
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-0153
  • Fax: 989-362-4683
Mailing address:
  • Phone: 989-362-0153
  • Fax: 989-362-4683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number5101015455
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: