Provider Demographics
NPI:1437160512
Name:OWENS, CYNTHIA DENISE (DO)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:DENISE
Last Name:OWENS
Suffix:
Gender:F
Credentials:DO
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 361052
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48236-5052
Mailing Address - Country:US
Mailing Address - Phone:313-671-9426
Mailing Address - Fax:
Practice Address - Street 1:5001 HARDY ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1308
Practice Address - Country:US
Practice Address - Phone:601-296-2090
Practice Address - Fax:601-296-2089
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007938207R00000X, 207RG0300X
VA0102202981207R00000X
WV0102202981208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1B4719OtherMEDICARE
MS00016377Medicaid