Provider Demographics
NPI:1437159274
Name:BOWLUS, THEODORE HENRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:HENRY
Last Name:BOWLUS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27121 OAKMEAD DR STE C
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2672
Mailing Address - Country:US
Mailing Address - Phone:567-277-8878
Mailing Address - Fax:419-353-4169
Practice Address - Street 1:27121 OAKMEAD DR STE C
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2672
Practice Address - Country:US
Practice Address - Phone:567-277-8878
Practice Address - Fax:419-353-4169
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-001781213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH176322OtherMEDICARE
OH0340698Medicaid
OHP01190586Medicare PIN
T80437Medicare UPIN
9180381Medicare ID - Type Unspecified