Provider Demographics
NPI:1467407932
Name:FOWLER OSTEOPATHIC CLINIC P.C./LYONS CLINIC OF FAMILY MEDICINE
Entity Type:Organization
Organization Name:FOWLER OSTEOPATHIC CLINIC P.C./LYONS CLINIC OF FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:POFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-593-2525
Mailing Address - Street 1:11017 W. THIRD STREET
Mailing Address - Street 2:BOX 19
Mailing Address - City:FOWLER
Mailing Address - State:MI
Mailing Address - Zip Code:48835
Mailing Address - Country:US
Mailing Address - Phone:989-593-2525
Mailing Address - Fax:989-593-3385
Practice Address - Street 1:11017 W. THIRD STREET
Practice Address - Street 2:BOX 19
Practice Address - City:FOWLER
Practice Address - State:MI
Practice Address - Zip Code:48835
Practice Address - Country:US
Practice Address - Phone:989-593-2525
Practice Address - Fax:989-593-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty