Basic Information
| Provider Information | |||||||||
| NPI: | 1467407932 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOWLER OSTEOPATHIC CLINIC P.C./LYONS CLINIC OF FAMILY MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11017 W. THIRD STREET | ||||||||
| Address2: | BOX 19 | ||||||||
| City: | FOWLER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895932525 | ||||||||
| FaxNumber: | 9895933385 | ||||||||
| Practice Location | |||||||||
| Address1: | 11017 W. THIRD STREET | ||||||||
| Address2: | BOX 19 | ||||||||
| City: | FOWLER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895932525 | ||||||||
| FaxNumber: | 9895933385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 06/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | POFF | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9895932525 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.