MEDICARE: MYCHELLE A. OWEN DO

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	207V00000X	Obstetrics & Gynecology Physician	34008554	OH
2	207V00000X	Obstetrics & Gynecology Physician	02005028A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861486680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYCHELLE A. OWEN DO

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11123 PARKVIEW PLAZA DR STE 101
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1707
Country	:	US
Telephone Number	:	260-425-6650
Fax Number	:	260-425-6649

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/13/2024

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Directions to “ MYCHELLE A. OWEN DO” Practice Location

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