Provider Demographics
NPI:1174564785
Name:OWENS, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:OWENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5131
Mailing Address - Fax:740-446-5486
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5131
Practice Address - Fax:740-446-5486
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-05-9908207R00000X
WV16693207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310917085111OtherCARESOURCE MEDICAID
001714057OtherMOUNTAIN STATE BCBS
WV0073060000Medicaid
000000007572OtherANTHEM BCBS
OH000000181839OtherUNISON MEDICAID
110062952OtherRR MEDICARE
OH0809389OtherMOLINA MEDICAID
OH000000181839OtherUNISON MEDICAID
001714057OtherMOUNTAIN STATE BCBS
WV0073060000Medicaid