Healthcare Provider Details

I. General information

NPI: 1073538534
Provider Name (Legal Business Name): ALLAM A KOWATLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALLAM A ALKOWATLI

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SHACKLEFORD WEST BLVD
LITTLE ROCK AR
72211-3714
US

IV. Provider business mailing address

7 SHACKLEFORD WEST BLVD
LITTLE ROCK AR
72211-3714
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-5860
  • Fax: 501-664-0889
Mailing address:
  • Phone: 501-664-5860
  • Fax: 501-664-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberE2545
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: