Provider Demographics
NPI:1083618466
Name:OWENS, LOUISE ANNE (MD)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:ANNE
Last Name:OWENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2453
Mailing Address - Country:US
Mailing Address - Phone:812-334-3303
Mailing Address - Fax:812-334-0842
Practice Address - Street 1:500 S MADISON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2453
Practice Address - Country:US
Practice Address - Phone:812-334-3303
Practice Address - Fax:812-334-0842
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D69749Medicare UPIN
IN542820Medicare ID - Type Unspecified