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General NPI Number Information
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NPI Number | 1053631259
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Entity Type | Individual
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Provider Name | BOWLVA MICHAEL LEE D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 9441 LBJ FWY SUITE 114
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City | DALLAS
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State | TX
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Zip | 75243-4635
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Country | US
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Telephone | 214-557-4111
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Fax | 972-972-8660
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Provider Business Mailing Address
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Address Line | 720 HIGHWAY 377, SUITE 140, PMB 155
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City | ROANOKE
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State | TX
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Zip | 76262-6893
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Country | US
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Telephone | 347-560-1640
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Fax | 972-972-8660
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | P2477
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License Number State | TX
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