Provider Demographics
NPI:1609976927
Name:BOWERS, TAMARA M (DO)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:M
Last Name:BOWERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:MCVAY
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:50 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2217
Mailing Address - Country:US
Mailing Address - Phone:248-338-5516
Mailing Address - Fax:248-338-5547
Practice Address - Street 1:50 N PERRY ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342
Practice Address - Country:US
Practice Address - Phone:248-338-5516
Practice Address - Fax:248-338-5547
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015454207P00000X
GA059128207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA598549056EMedicaid
GA01057454OtherAMERIGROUP
GA598549056BMedicaid
GA598549056CMedicaid
GA598549056AMedicaid
GA598549056GMedicaid
GA598549056Medicaid
SCG59128Medicaid
GA598549056DMedicaid
GA598549056Medicaid
SCG59128Medicaid
I06352Medicare UPIN