Individual
DR. DALLIS MARK BOWDITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1201 MICHIGAN AVE, SUITE 140, LOGANSPORT, IN 46947-1580
(574) 753-1462
(574) 753-1465
Mailing address
1201 MICHIGAN AVE, SUITE 140, LOGANSPORT, IN 46947-1580
(574) 753-1462
(574) 753-1465
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01032465A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000546802
ANTHEM BLUE CROSS
—
01
—
080096741
MEDICARE RAILROAD
—
05
—
100070810
—
IN
01
—
112810C
OLD MEDICARE ID #
—
01
—
4216390
AETNA ID
IN
01
—
6148784003
CIGNA ID
IN
Enumeration date
05/27/2005
Last updated
12/01/2015
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