Provider Demographics
NPI:1245289446
Name:BOWER, CHARLES W (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:BOWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:22410 CANYON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-9035
Mailing Address - Country:US
Mailing Address - Phone:312-590-6170
Mailing Address - Fax:
Practice Address - Street 1:1855 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4853
Practice Address - Country:US
Practice Address - Phone:574-533-7476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066241A2085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095769Medicaid
H40350Medicare UPIN