Provider Demographics
NPI:1902934573
Name:LOWE, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LOWE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19992 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1622
Mailing Address - Country:US
Mailing Address - Phone:313-885-1588
Mailing Address - Fax:
Practice Address - Street 1:16841 KERCHEVAL PL
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1553
Practice Address - Country:US
Practice Address - Phone:313-885-5400
Practice Address - Fax:313-885-2893
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL907492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20056OtherSPECTERA
MIMI3768OtherEYEMED ID
MIMI3768OtherEYEMED ID