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General NPI Number Information
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NPI Number | 1639249329
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Entity Type | Organization
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Legal Business Name | DR. THEODORE BOWLUS, DPM, INC.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 27121 OAKMEAD DR STE C
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City | PERRYSBURG
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State | OH
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Zip | 43551-2672
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Country | US
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Telephone | 567-277-8878
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Fax | 419-353-4169
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Provider Business Mailing Address
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Address Line | 27121 OAKMEAD DR STE C
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City | PERRYSBURG
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State | OH
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Zip | 43551-2672
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Country | US
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Telephone | 567-277-8878
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Fax | 419-353-4169
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Authorized Official
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Title or Position | OWNER
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Name | THEODORE HENRY BOWLUS
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Credential | DPM
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Telephone | 419-874-4494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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