1346278835 NPI number — KENNETH DUANE BOWMAN M.D.

Table of content: KENNETH DUANE BOWMAN M.D. (NPI 1346278835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346278835 NPI number — KENNETH DUANE BOWMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWMAN
Provider First Name:
KENNETH
Provider Middle Name:
DUANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346278835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11995 SINGLETREE LN STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-5349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-595-1301
Provider Business Mailing Address Fax Number:
612-294-4903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11995 SINGLETREE LN STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDEN PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55344-5349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-595-1301
Provider Business Practice Location Address Fax Number:
612-294-4903
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  01057766 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64106941 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00764115 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 063182 . This is a "SIHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00242551 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200523120 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000371886 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00632696 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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