Bowditch, Dallis Mark

Bowditch, Dallis Mark is an individual health care provider with primary practice located at 1201 Michigan Ave Suite 140, Logansport IN 46947-1580. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Bowditch, Dallis Mark can be contacted via phone (574) 753-1462.

Contact Information

Primary practice address
1201 Michigan Ave Suite 140 Logansport IN 46947-1580
Phone: (574) 753-1462
Fax: (574) 753-1465
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01032465A Indiana

Profile Details

NPI number 1790788255
LBN Legal business name Bowditch, Dallis Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 27th, 2005
Last updated Dec 1st, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790788255 NPPES
Indiana Other 4216390 AETNA ID
Indiana MEDICAID 100070810 AETNA ID
Indiana Other 000000546802 AETNA ID
Indiana Other 6148784003 AETNA ID
Indiana Other 080096741 AETNA ID
Indiana Other 112810C AETNA ID

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