Healthcare Provider Details

I. General information

NPI: 1336077338
Provider Name (Legal Business Name): STEVEN DIONTE BOWIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17805 LAKE SHORE BLVD APT 205
CLEVELAND OH
44119-1224
US

IV. Provider business mailing address

17805 LAKE SHORE BLVD APT 205
CLEVELAND OH
44119-1224
US

V. Phone/Fax

Practice location:
  • Phone: 216-403-5343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRS020732
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: