Provider Demographics
NPI:1659306140
Name:MICHAEL D. BOWMAN, MD, PC
Entity Type:Organization
Organization Name:MICHAEL D. BOWMAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-633-8830
Mailing Address - Street 1:PO BOX 850547
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0547
Mailing Address - Country:US
Mailing Address - Phone:251-633-8830
Mailing Address - Fax:251-633-6862
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE B216
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-633-8830
Practice Address - Fax:251-633-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00058904Medicaid
AL00058904Medicaid