MEDICARE: DR. KEVIN WAYNE BOWERS D.O.

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	208D00000X	General Practice Physician	34-00-7885-B	OH

General Provider Information

NPI Number	:	1790981231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN WAYNE BOWERS D.O.

Provider Business Mailing Address
First Line	:	1866 PINNACLE CLUB DR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8372
Country	:	US
Telephone Number	:	614-937-5470
Fax Number	:	614-801-5677

Provider Business Practice Location Address
First Line	:	1866 PINNACLE CLUB DR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8372
Country	:	US
Telephone Number	:	614-937-5470
Fax Number	:	614-801-5677

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/08/2007

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