Provider Demographics
NPI:1669826319
Name:LOWE, PHILEMON
Entity Type:Individual
Prefix:
First Name:PHILEMON
Middle Name:
Last Name:LOWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29401 LEEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1609
Mailing Address - Country:US
Mailing Address - Phone:248-799-8200
Mailing Address - Fax:248-799-8208
Practice Address - Street 1:29401 LEEMOOR DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1609
Practice Address - Country:US
Practice Address - Phone:248-799-8200
Practice Address - Fax:248-799-8208
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2584343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)