MEDICARE: LOWELL MEDICAL SPECIALISTS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301063084	MI
2	208000000X	Pediatrics Physician	4301050027	MI
3	208000000X	Pediatrics Physician	4301063084	MI
4	207R00000X	Internal Medicine Physician	4301050027	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB8671	OTHER	MI	MEDICARE RAILROAD
2	110089735	OTHER	MI	MEDICARE RAILROAD
4	0D14849	OTHER	MI	MEDICARE
6	110110939	OTHER	MI	MEDICARE RAILROAD
13	0D14849	OTHER	MI	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	110D148490	OTHER	MI	BCBSM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	4119931	OTHER	MI	BCBSM
9	4178342	OTHER	MI	BCBSM
10	1104119931	OTHER	MI	BCBSM
11	1104178342	OTHER	MI	BCBSM
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508034141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWELL MEDICAL SPECIALISTS, PC

Provider Business Mailing Address
First Line	:	1150 N HUDSON ST
Second Line	:
City	:	LOWELL
State	:	MI
Zip	:	49331-1000
Country	:	US
Telephone Number	:	616-897-8436
Fax Number	:	616-897-5364

Provider Business Practice Location Address
First Line	:	1150 N HUDSON ST
Second Line	:
City	:	LOWELL
State	:	MI
Zip	:	49331-1000
Country	:	US
Telephone Number	:	616-897-8436
Fax Number	:	616-897-5364

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARY DAWSON
Credential	:
Telephone Number	:	616-897-8436

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	04/25/2008

Similar Medicare Providers

1962482653 — DR. MARTIN D VREDENBURG D.D.S.
Practice Location Address:

1150 N HUDSON ST
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49331-1000

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1407140197 — SPECTRUM HEALTH PRIMARY CARE PARTNERS
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1922429612 — DR. ROBERT CAESAR BELMONTE II D.C
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1154098374 — MARTIN D VREDENBURG DDS PC
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1538979208 — CHENELE YOUNG
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Directions to “LOWELL MEDICAL SPECIALISTS, PC ” Practice Location

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