| Dr Bruce A Fowler P C | |
|
2090 Celebration Dr Ne Suite 212 Grand Rapids MI 49525-9200 | |
| (616) 450-4601 | |
| (616) 608-0108 |
| Full Name | Dr Bruce A Fowler P C |
|---|---|
| Speciality | Psychologist |
| Location | 2090 Celebration Dr Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Bruce Allen Fowler (PRESIDENT) |
| Authorized Official Contact | 6164504601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Bruce A Fowler P C 2090 Celebration Dr Ne Suite 212 Grand Rapids MI 49525-9200 Ph: (616) 450-4601 | Dr Bruce A Fowler P C 2090 Celebration Dr Ne Suite 212 Grand Rapids MI 49525-9200 Ph: (616) 450-4601 |
| NPI Number | 1992903363 |
|---|---|
| Provider Enumeration Date | 07/06/2007 |
| Last Update Date | 05/16/2024 |
| Certification Date | 05/16/2024 |
| Medicare PECOS PAC ID | 0446342646 |
|---|---|
| Medicare Enrollment ID | O20070817000164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992903363 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301006137 (Michigan) | Primary |
| Provider Name | Bruce A Fowler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881792497 PECOS PAC ID: 5193817393 Enrollment ID: I20070817000137 |
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