Provider Demographics
NPI:1770559320
Name:STOWITTS, JEFFREY B (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:STOWITTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:406 EAST ELM STREET
Mailing Address - Street 2:PO BOX 730
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811
Mailing Address - Country:US
Mailing Address - Phone:989-584-3131
Mailing Address - Fax:989-584-6734
Practice Address - Street 1:1014 EAST WASHINGTON
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838
Practice Address - Country:US
Practice Address - Phone:616-754-7145
Practice Address - Fax:616-754-7110
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICA8440OtherRAILRAOD MEDICARE PTAN
MI3472239Medicaid
MI3472239Medicaid
MIE96008016Medicare PIN