Provider Demographics
NPI:1568529485
Name:OWENS, LOUIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:OWENS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MIDDLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3636
Mailing Address - Country:US
Mailing Address - Phone:302-629-6611
Mailing Address - Fax:
Practice Address - Street 1:10335 N PORT WASHINGTON RD
Practice Address - Street 2:250
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5763
Practice Address - Country:US
Practice Address - Phone:262-240-9870
Practice Address - Fax:262-240-9895
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100024312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE415601N48Medicare PIN
DEC48745Medicare UPIN