Basic Information
| Provider Information | |||||||||
| NPI: | 1063777985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWKER | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1339 FIELDING STREET | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196042185 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4201 ST ANTOINE ST | ||||||||
| Address2: | DETROIT MEDICAL CENTER | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137457514 | ||||||||
| FaxNumber: | 3137451873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | R73514 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0122X | 4301112110 | MI | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.