Individual
MYCHELLE A. OWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
11123 PARKVIEW PLAZA DR STE 101, FORT WAYNE, IN 46845-1707
(260) 425-6650
(260) 425-6649
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
02005028A
IN
207V00000X
Obstetrics & Gynecology Physician
34008554
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2607601
—
OH
05
—
427702
—
AZ
Enumeration date
09/08/2005
Last updated
08/13/2024
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