Provider Demographics
NPI:1679794127
Name:FOWLER, MAIRE ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:MAIRE
Middle Name:ELIZABETH
Last Name:FOWLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 NW HUNTERS RIDGE TER
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66618-2509
Mailing Address - Country:US
Mailing Address - Phone:785-246-3733
Mailing Address - Fax:
Practice Address - Street 1:3405 NW HUNTERS RIDGE TER
Practice Address - Street 2:SUITE 100
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2509
Practice Address - Country:US
Practice Address - Phone:785-246-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-32672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200531070AMedicaid
KS200531070AMedicaid