Provider Demographics
NPI:1093717522
Name:BOWEN, KIM D (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:D
Last Name:BOWEN
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:PO BOX 30790
Mailing Address - Street 2:MEDINA EMERGENCY ASSOCIATES LTD
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-0790
Mailing Address - Country:US
Mailing Address - Phone:866-266-8189
Mailing Address - Fax:330-654-9086
Practice Address - Street 1:1000 E WASHINGTON
Practice Address - Street 2:MEDINA GENERAL HOSPITAL ED
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-654-1185
Practice Address - Fax:330-654-9086
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059725B207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0785673Medicaid
E76031Medicare UPIN
OHB00732394Medicare PIN