Provider Demographics
NPI:1760501662
Name:JOWKAR, ABBAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:A
Last Name:JOWKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ABBAS
Other - Middle Name:A
Other - Last Name:JOWKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:231-672-2120
Mailing Address - Fax:
Practice Address - Street 1:1675 LEAHY ST STE 401A
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5547
Practice Address - Country:US
Practice Address - Phone:231-672-4243
Practice Address - Fax:231-727-4214
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2369902084N0008X, 390200000X
MI43010968882084N0400X, 2084N0600X, 2084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP35120026Medicare PIN