Provider Demographics
NPI:1053330589
Name:MCGOWAN, MICHELE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 CITRUS TOWER BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6886
Mailing Address - Country:US
Mailing Address - Phone:352-242-2502
Mailing Address - Fax:352-242-0316
Practice Address - Street 1:3150 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-242-2502
Practice Address - Fax:352-242-0316
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2977213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65755OtherBC/BS
FL043604213OtherTRICARE
FL340295900Medicaid
FL043604213OtherCIGNA
FL4690780001OtherPALMETTO GBA
FL65755YMedicare PIN
FL4690780001OtherPALMETTO GBA
FL043604213OtherTRICARE