1467407932 NPI number — FOWLER OSTEOPATHIC CLINIC P.C./LYONS CLINIC OF FAMILY MEDICINE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467407932 NPI number — FOWLER OSTEOPATHIC CLINIC P.C./LYONS CLINIC OF FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOWLER OSTEOPATHIC CLINIC P.C./LYONS CLINIC OF FAMILY MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1467407932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11017 W. THIRD STREET
Provider Second Line Business Mailing Address:
BOX 19
Provider Business Mailing Address City Name:
FOWLER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-593-2525
Provider Business Mailing Address Fax Number:
989-593-3385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11017 W. THIRD STREET
Provider Second Line Business Practice Location Address:
BOX 19
Provider Business Practice Location Address City Name:
FOWLER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-593-2525
Provider Business Practice Location Address Fax Number:
989-593-3385
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POFF
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PHYSICIAN/OFFICER
Authorized Official Telephone Number:
989-593-2525

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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