Basic Information
Provider Information | |||||||||
NPI: | 1083716724 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOWN | ||||||||
FirstName: | STEVEN | ||||||||
MiddleName: | JOHN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5900 BYRON CENTER AVE SW | ||||||||
Address2: | MEDICAL ADMINISTRATION | ||||||||
City: | WYOMING | ||||||||
State: | MI | ||||||||
PostalCode: | 495199606 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6162523243 | ||||||||
FaxNumber: | 6162520260 | ||||||||
Practice Location | |||||||||
Address1: | 2221 HEALTH DR SW | ||||||||
Address2: |   | ||||||||
City: | WYOMING | ||||||||
State: | MI | ||||||||
PostalCode: | 49509 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6162524410 | ||||||||
FaxNumber: | 6162524480 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/02/2006 | ||||||||
LastUpdateDate: | 12/01/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 010723 | MI | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 3061153 | 05 | MI |   | MEDICAID | 3230766 | 05 | MI |   | MEDICAID | 5410099 | 01 | MI | BLUE CARE NETWORK | OTHER | 4112103 | 05 | MI |   | MEDICAID | 110793 | 01 |   | CARE CHOICES | OTHER | M031721 | 01 |   | CHAMPUS | OTHER | 5410099 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER |