Provider Demographics
NPI:1699838243
Name:DOWAGIAC MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:DOWAGIAC MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-782-2111
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-0378
Mailing Address - Country:US
Mailing Address - Phone:269-782-2111
Mailing Address - Fax:269-782-9852
Practice Address - Street 1:400 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1704
Practice Address - Country:US
Practice Address - Phone:269-782-2111
Practice Address - Fax:269-782-9852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110A410240OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI233904OtherOSCAR
MI111371059Medicaid
MI233904OtherOSCAR
MI111371059Medicaid
MI233904Medicare PIN