Provider Demographics
NPI:1255577474
Name:MOWERY, DAVID M (PA)
Entity type:Individual
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First Name:DAVID
Middle Name:M
Last Name:MOWERY
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Gender:M
Credentials:PA
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Mailing Address - Street 1:4201 SAINT ANTOINE ST
Mailing Address - Street 2:UHC - 5D MAILBOX #226
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4405
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:2ND FLOOR CARL'S BLDG
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5541
Practice Address - Fax:313-993-2948
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2015-11-12
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Provider Licenses
StateLicense IDTaxonomies
MI5601005421363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical