Provider Demographics
NPI:1548568694
Name:BOWERS, MIKAELA (DO)
Entity Type:Individual
Prefix:DR
First Name:MIKAELA
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MIKAELA
Other - Middle Name:MARIE
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8536 PALMETTO COMMERCE PKWY STE 401
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-6700
Mailing Address - Country:US
Mailing Address - Phone:843-402-5001
Mailing Address - Fax:843-724-2653
Practice Address - Street 1:316 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1113
Practice Address - Country:US
Practice Address - Phone:843-724-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51248207P00000X
CA20A14049207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC512486Medicaid