Provider Demographics
NPI:1588082051
Name:OWINGS, JOHN THOMAS (NP-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:OWINGS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 2ND AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2739
Mailing Address - Country:US
Mailing Address - Phone:313-748-4200
Mailing Address - Fax:313-748-4187
Practice Address - Street 1:25373 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1425
Practice Address - Country:US
Practice Address - Phone:586-261-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2359348163W00000X
MIL163015363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse