Provider Demographics
NPI:1578650123
Name:LOWRY, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:LOWRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3299 N WELLNESS DR
Mailing Address - Street 2:BUILDING C, SUITE 240
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7269
Mailing Address - Country:US
Mailing Address - Phone:616-738-4420
Mailing Address - Fax:616-738-4432
Practice Address - Street 1:3299 N WELLNESS DR
Practice Address - Street 2:BUILDING C, SUITE 240
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7269
Practice Address - Country:US
Practice Address - Phone:616-738-4420
Practice Address - Fax:616-738-4432
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301075621207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDL075621OtherSTATE LICENSE
MIST003962OtherSTATE LICENSE#
MI1407010792OtherBXMI
MI104721043Medicaid
MIH18003Medicare UPIN
MIST003962OtherSTATE LICENSE#
MI104721043Medicaid