Provider Demographics
NPI:1992014443
Name:BOWE, MICHAEL A (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:BOWE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:890 W ELLIOT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5102
Mailing Address - Country:US
Mailing Address - Phone:480-545-2787
Mailing Address - Fax:480-545-1434
Practice Address - Street 1:415 N VAL VISTA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-7058
Practice Address - Country:US
Practice Address - Phone:480-654-5661
Practice Address - Fax:480-654-5663
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2013-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ5359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ810804Medicaid
AZ810804Medicaid