Provider Demographics
NPI:1114102704
Name:ROY AND FOWLER ASSOCIATES
Entity Type:Organization
Organization Name:ROY AND FOWLER ASSOCIATES
Other - Org Name:YPSILANTI MEDICAL AND DRUG REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-483-9900
Mailing Address - Street 1:880 N FORD BLVD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-4136
Mailing Address - Country:US
Mailing Address - Phone:734-483-9900
Mailing Address - Fax:734-483-9903
Practice Address - Street 1:880 N FORD BLVD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-4136
Practice Address - Country:US
Practice Address - Phone:734-483-9900
Practice Address - Fax:734-483-9903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST INDUSTRIAL AND MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-02
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P20820OtherMEDICARE GROUP