Basic Information
Provider Information
NPI: 1306846431
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROWENS
FirstName: BRADLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25925 TELEGRAPH RD
Address2: 210
City: SOUTHFIELD
State: MI
PostalCode: 480342518
CountryCode: US
TelephoneNumber: 2487460342
FaxNumber: 2487460308
Practice Location
Address1: 47601 GRAND RIVER AVE
Address2: 2ND FLOOR
City: NOVI
State: MI
PostalCode: 483741233
CountryCode: US
TelephoneNumber: 2484654290
FaxNumber: 2484654883
Other Information
ProviderEnumerationDate: 07/29/2005
LastUpdateDate: 07/17/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X4301406382MIY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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