Provider Demographics
NPI:1316622764
Name:SOWELL, MICHAEL ANGELO JR
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANGELO
Last Name:SOWELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 ELLERY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2543
Mailing Address - Country:US
Mailing Address - Phone:380-231-8954
Mailing Address - Fax:
Practice Address - Street 1:4747 ELLERY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2543
Practice Address - Country:US
Practice Address - Phone:380-231-8954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization