1205029030 NPI number — MICHAEL R KOWALSKI DC PLLC

Table of content: (NPI 1205029030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205029030 NPI number — MICHAEL R KOWALSKI DC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL R KOWALSKI DC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205029030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8006 SHEPHERDSVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40219-4050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-964-9800
Provider Business Mailing Address Fax Number:
502-964-1847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8006 SHEPHERDSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40219-4050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-964-9800
Provider Business Practice Location Address Fax Number:
502-964-1847
Provider Enumeration Date:
08/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOWALSKI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
502-964-9800

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4524 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 613993 . This is a "ACN GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7189402 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000275184 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50000867 GROUP ID . This is a "PASSPORT HEALTHPLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3463110 . This is a "CIGNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 85002483 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50000868 PERSONAL . This is a "PASSPORT HEALTHPLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 613993 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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