LOWELL MEDICAL SPECIALISTS, PC

Provider Demographics

• NPI: 1508034141
• Name: LOWELL MEDICAL SPECIALISTS, PC
• Entity Type: Organization
• Organization Name: LOWELL MEDICAL SPECIALISTS, PC
• Authorized Official - Title/Position: OFFICE MANAGER
• Authorized Official - First Name: MARY
• Authorized Official - Last Name: DAWSON
• Authorized Official - Phone: 616-897-8436
• Mailing Address - Street 1: 1150 N HUDSON ST
• Mailing Address - City: LOWELL
• Mailing Address - State: MI
• Mailing Address - Zip Code: 49331-1000
• Mailing Address - Country: US
• Mailing Address - Phone: 616-897-8436
• Mailing Address - Fax: 616-897-5364
• Practice Address - Street 1: 1150 N HUDSON ST
• Practice Address - City: LOWELL
• Practice Address - State: MI
• Practice Address - Zip Code: 49331-1000
• Practice Address - Country: US
• Practice Address - Phone: 616-897-8436
• Practice Address - Fax: 616-897-5364
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2008-02-18
• Last Update Date: 2008-04-25

Provider Licenses

State	License ID	Taxonomies
MI	4301050027	207R00000X, 208000000X
MI	4301063084	207R00000X, 208000000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	CB8671	Other	MEDICARE RAILROAD
MI	110089735	Other	MEDICARE RAILROAD
MI	110D148490	Other	BCBSM
MI	0D14849	Other	MEDICARE
MI	103062947	Medicaid
MI	110110939	Other	MEDICARE RAILROAD
MI	3088774	Medicaid
MI	4119931	Other	BCBSM
MI	4178342	Other	BCBSM
MI	1104119931	Other	BCBSM
MI	1104178342	Other	BCBSM
MI	103088774	Medicaid
MI	0D14849	Other	MEDICARE RAILROAD
MI	3062947	Medicaid
MI	110089735	Other	MEDICARE RAILROAD
MI	103088774	Medicaid
MI	0D14849001	Medicare PIN