Basic Information
| Provider Information | |||||||||
| NPI: | 1124042437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWEN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 475 IRVING AVE | ||||||||
| Address2: | SUITE 418 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154753999 | ||||||||
| FaxNumber: | 3154704014 | ||||||||
| Practice Location | |||||||||
| Address1: | 475 IRVING AVE | ||||||||
| Address2: | SUITE 418 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154753999 | ||||||||
| FaxNumber: | 3154704014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 08/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 125796-1 | NY | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.