Healthcare Provider Details

I. General information

NPI: 1518927698
Provider Name (Legal Business Name): SUSAN H BOWERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD
MINNEAPOLIS MN
55426-4702
US

IV. Provider business mailing address

PO BOX 385760
BLOOMINGTON MN
55438-5760
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-5290
  • Fax:
Mailing address:
  • Phone: 952-944-0970
  • Fax: 952-944-1761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number33269
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number33269
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: