Provider Demographics
NPI:1174785182
Name:BOWEN, MATTHEW ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALLEN
Last Name:BOWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1450 FARR RD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-9738
Mailing Address - Country:US
Mailing Address - Phone:231-739-9095
Mailing Address - Fax:231-739-6439
Practice Address - Street 1:1450 FARR RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-9738
Practice Address - Country:US
Practice Address - Phone:231-739-9095
Practice Address - Fax:231-739-6439
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102283207YX0007X, 207YX0602X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6945001OtherPTAN