Provider Demographics
NPI:1033141783
Name:GOWDA, UMESH G (MD)
Entity Type:Individual
Prefix:DR
First Name:UMESH
Middle Name:G
Last Name:GOWDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S LIVERNOIS RD
Mailing Address - Street 2:276
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1837
Mailing Address - Country:US
Mailing Address - Phone:248-651-1155
Mailing Address - Fax:248-651-8537
Practice Address - Street 1:1101 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1863
Practice Address - Country:US
Practice Address - Phone:248-651-1155
Practice Address - Fax:248-651-8537
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIUG4301040816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0806353751OtherBCBS
MI3116565Medicaid
MI4983038Medicaid
MIAG1289455OtherDEA
MI4983038Medicaid
MI0P43200Medicare ID - Type Unspecified
MI0630180Medicare ID - Type Unspecified