Provider Demographics
NPI:1205890464
Name:ROWE, BRUCE A (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:ROWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M424
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-3350
Mailing Address - Fax:269-349-2403
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-424
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-3350
Practice Address - Fax:269-349-2403
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301070572207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7434410OtherAETNA
MI2003906122OtherBCBS OF MICHIGAN
MI1205890464Medicaid
MIP115351OtherBLUE CARE NETWORK
MI09-30233OtherIBA/PHP
MI4423005Medicaid
OH383309299-10OtherBWC - OHIO WORK COMP
0P23000001Medicare PIN
MI0C97625148Medicare PIN
MI0C97618274Medicare PIN
MI2003906122OtherBCBS OF MICHIGAN