MEDICARE: DONALD D MCGOWAN DPM

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	213E00000X	Podiatrist	07000684	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1629157680	OTHER	IN	NPI
2	000000088330	OTHER	IN	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1932389244	OTHER	IN	NPI
5	M300056628	OTHER	IN	PTAN

General Provider Information

NPI Number	:	1629157680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD D MCGOWAN DPM

Provider Business Mailing Address
First Line	:	3015 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2347
Country	:	US
Telephone Number	:	574-288-8200
Fax Number	:	574-288-8226

Provider Business Practice Location Address
First Line	:	3015 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2347
Country	:	US
Telephone Number	:	574-288-8200
Fax Number	:	574-288-8226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	11/19/2012

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Directions to “ DONALD D MCGOWAN DPM” Practice Location

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