Provider Demographics
NPI:1376672527
Name:BOWERS, PHILIP R (CRNA)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:BOWERS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30200 TELEGRAPH RD STE 220
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4506
Mailing Address - Country:US
Mailing Address - Phone:248-258-5058
Mailing Address - Fax:
Practice Address - Street 1:30200 TELEGRAPH RD STE 220
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4506
Practice Address - Country:US
Practice Address - Phone:248-258-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704156709367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4310905Medicaid
MI0N21370001Medicare ID - Type Unspecified
MI430060366Medicare ID - Type UnspecifiedRAILROAD