Healthcare Provider Details

I. General information

NPI: 1922462092
Provider Name (Legal Business Name): COLLIN ELLOTT BOWMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 COMMANCHE AVE
GREEN BAY WI
54313-5751
US

IV. Provider business mailing address

PO BOX 22487
GREEN BAY WI
54305-2487
US

V. Phone/Fax

Practice location:
  • Phone: 920-435-8326
  • Fax: 920-430-4659
Mailing address:
  • Phone: 920-445-7210
  • Fax: 920-445-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number81538-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: