Provider Demographics
NPI:1790736692
Name:DAVID W LOWRY MD PC
Entity Type:Organization
Organization Name:DAVID W LOWRY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-738-4420
Mailing Address - Street 1:3299 NORTH WELLNESS DR
Mailing Address - Street 2:SUITE 240 BUILDING C
Mailing Address - City:HOLLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424
Mailing Address - Country:US
Mailing Address - Phone:616-738-4420
Mailing Address - Fax:616-738-4432
Practice Address - Street 1:3299 NORTH WELLNESS DR
Practice Address - Street 2:SUITE 240 BUILDING C
Practice Address - City:HOLLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424
Practice Address - Country:US
Practice Address - Phone:616-738-4420
Practice Address - Fax:616-738-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075621207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1407010792OtherBCBSM MI
MIST003962OtherSTATE LICENSE #
MIDL075621OtherSTATE LICENSE #
MI104721043Medicaid
MI1407010792OtherBCBSM MI
MI0P17930Medicare PIN
MIDL075621OtherSTATE LICENSE #