DR. DALLIS MARK BOWDITCH M.D. NPI 1790788255

NPI Information

  • NPI: 1790788255
  • Provider Name: DR. DALLIS MARK BOWDITCH, M.D.
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1201 MICHIGAN AVE
    SUITE 140
    LOGANSPORT, IN
    ZIP 46947
  • Phone: (574) 753-1462

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NPI Details

DR. Dallis Mark Bowditch, M.D. is a family medicine in Logansport, IN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Dallis Mark Bowditch, M.D. NPI is 1790788255. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1201 MICHIGAN AVE
SUITE 140
LOGANSPORT, IN
ZIP 46947-580
Phone: (574) 753-1462
Fax: (574) 753-1465

The NPI 1790788255 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/27/2005 and was last updated on 12/1/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine01032465AINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1B28389MEDICARE UPIN
2100070810MEDICAIDINDIANA
36148784003OTHERINDIANACIGNA ID
4000000546802OTHERANTHEM BLUE CROSS
54216390OTHERINDIANAAETNA ID
6940670A4MEDICARE PININDIANA
7080096741OTHERMEDICARE RAILROAD
8112810COTHEROLD MEDICARE ID #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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