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General NPI Number Information
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NPI Number | 1346364619
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Entity Type | Organization
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Legal Business Name | NORTHWEST INDUSTRIAL AND MEDICAL SERVICES PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 9600 DEXTER AVE
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City | DETROIT
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State | MI
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Zip | 48206-1816
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Country | US
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Telephone | 313-894-7881
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Fax |
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Provider Business Mailing Address
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Address Line | 9600 DEXTER AVE
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City | DETROIT
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State | MI
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Zip | 48206-1816
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Country | US
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Telephone | 313-894-7881
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Fax |
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | CARL DENNIS FOWLER
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Credential | M.D.
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Telephone | 313-894-7881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | CF045243
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License Number State | MI
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