Provider Demographics
NPI:1740654037
Name:BOWEN, GEORGE JR
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BOWEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E 77TH ST
Mailing Address - Street 2:2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2308
Mailing Address - Country:US
Mailing Address - Phone:219-290-0914
Mailing Address - Fax:
Practice Address - Street 1:4843 TURNER CT
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-5829
Practice Address - Country:US
Practice Address - Phone:219-290-0914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)