Individual
ELMER WILLIAM FOWLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO PL
Contact information
Practice address
3351 CLAYSTONE ST SE, SUITE 212, GRAND RAPIDS, MI 49546-5781
(616) 954-1991
(616) 954-1998
Mailing address
3351 CLAYSTONE ST SE, SUITE 212, GRAND RAPIDS, MI 49546-5781
(616) 954-1991
(616) 954-1998
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
5101007546
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26221802854050
—
MI
Enumeration date
09/21/2006
Last updated
11/27/2023
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