Provider Demographics
NPI:1922027473
Name:FOWLER, JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FOWLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60311 M 43
Mailing Address - Street 2:SUITE M273
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-9617
Mailing Address - Country:US
Mailing Address - Phone:269-214-6911
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M273
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-381-0180
Practice Address - Fax:269-381-7347
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP53336Medicare UPIN
MI0N46700Medicare ID - Type Unspecified