Healthcare Provider Details

I. General information

NPI: 1871807248
Provider Name (Legal Business Name): MICHAEL BOWEN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 FALL HILL AVE
FREDERICKSBURG VA
22401-3000
US

IV. Provider business mailing address

3310 FALL HILL AVE
FREDERICKSBURG VA
22401-3000
US

V. Phone/Fax

Practice location:
  • Phone: 540-373-4602
  • Fax: 540-310-0100
Mailing address:
  • Phone: 540-373-4602
  • Fax: 540-310-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005558
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016005558
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301202
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103301202
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: