Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301102283 | MI |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 4301102283 | MI |
NPI | 1174785182 |
---|---|
Provider Name | Dr. Matthew Allen Bowen |
First Address | Norton Shores, MI 49444-9738 |
Second Address | Norton Shores, MI 49444-9738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 12/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MI6945001 | PTAN (01) | MI |