Provider Demographics
NPI:1811384282
Name:BOWEN, RANDY C (MD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:C
Last Name:BOWEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:259 E ERIE ST STE 1520
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3111
Mailing Address - Country:US
Mailing Address - Phone:312-695-8150
Mailing Address - Fax:312-695-3652
Practice Address - Street 1:259 E ERIE ST STE 1520
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3111
Practice Address - Country:US
Practice Address - Phone:312-695-8150
Practice Address - Fax:312-695-3652
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2022-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI1811384282207W00000X
OH35.135844207W00000X
IAMD-47095207W00000X
IL036159824207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology