Basic Information
| Provider Information | |||||||||
| NPI: | 1841235884 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOWE | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 E BROAD ST STE 218 | ||||||||
| Address2: | |||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440356447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403297310 | ||||||||
| FaxNumber: | 4403297749 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 E BROAD ST STE 218 | ||||||||
| Address2: | |||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440356447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403297310 | ||||||||
| FaxNumber: | 4403297749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 12/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 34008442 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2675618 | 05 | OH | MEDICAID |