1841221413 NPI number — DAVID A DOWELL DPM

Table of content: DAVID A DOWELL DPM (NPI 1841221413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841221413 NPI number — DAVID A DOWELL DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOWELL
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1841221413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 HUEHL RD UNIT 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60062-2319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-504-5000
Provider Business Mailing Address Fax Number:
844-443-0082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 HUEHL RD UNIT 13
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60062-2319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-504-5000
Provider Business Practice Location Address Fax Number:
844-443-0082
Provider Enumeration Date:
07/05/2006

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: 213E00000X , with the licence number:  000709 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 266 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 791 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112888 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 307642520 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q030042 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1841221413 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".