Individual
DONALD D MCGOWAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
3015 MISHAWAKA AVE, SOUTH BEND, IN 46615-2347
(574) 288-8200
(574) 288-8226
Mailing address
3015 MISHAWAKA AVE, SOUTH BEND, IN 46615-2347
(574) 288-8200
(574) 288-8226
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000684
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000088330
ANTHEM
IN
05
—
100091280A
—
IN
01
—
1629157680
NPI
IN
01
—
1932389244
NPI
IN
01
—
M300056628
PTAN
IN
Enumeration date
11/02/2006
Last updated
11/19/2012
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