Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101015543 | MI |
NPI | 1003850603 |
---|---|
Provider Name | Dr. Steven A. Owens |
First Address | Mason, MI 48854-2063 |
Second Address | Mason, MI 48854-2063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 29/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H92688 | (02) | MI |