Provider Demographics
NPI:1518192467
Name:MCGOWAN, JOZIA COLEEN (DO)
Entity Type:Individual
Prefix:
First Name:JOZIA
Middle Name:COLEEN
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JOZIA
Other - Middle Name:COLEEN
Other - Last Name:LUTACKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5844 NW BARRY RD
Mailing Address - Street 2:STE 270
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1465
Mailing Address - Country:US
Mailing Address - Phone:816-880-2600
Mailing Address - Fax:816-880-2640
Practice Address - Street 1:5844 NW BARRY RD
Practice Address - Street 2:STE 270
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1465
Practice Address - Country:US
Practice Address - Phone:816-880-2600
Practice Address - Fax:816-880-2640
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018158207R00000X
MOMO2012035077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine