Provider Demographics
NPI:1124042437
Name:OWEN, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:OWEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:SUITE 418
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-475-3999
Mailing Address - Fax:315-470-4014
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:SUITE 418
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-475-3999
Practice Address - Fax:315-470-4014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-08-26
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Provider Licenses
StateLicense IDTaxonomies
NY125796-1207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB79405Medicare UPIN