Provider Demographics
NPI:1952982977
Name:MOWERY, MYLES LAYNE (DO, MBA)
Entity Type:Individual
Prefix:
First Name:MYLES
Middle Name:LAYNE
Last Name:MOWERY
Suffix:
Gender:M
Credentials:DO, MBA
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Mailing Address - Street 1:100 MICHIGAN ST NE STE A601
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-391-5243
Mailing Address - Fax:
Practice Address - Street 1:3246 NORTH EVERGREEN DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-459-7225
Practice Address - Fax:164-597-2716
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5151015205208600000X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery