Provider Demographics
NPI:1689637308
Name:THROWER, DAVID B (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:THROWER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 ROMENCE RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-3472
Mailing Address - Country:US
Mailing Address - Phone:269-329-7575
Mailing Address - Fax:
Practice Address - Street 1:576 ROMENCE RD
Practice Address - Street 2:SUITE 124
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-3472
Practice Address - Country:US
Practice Address - Phone:269-329-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB45902Medicare UPIN
MI5390016Medicare ID - Type Unspecified