Healthcare Provider Details

I. General information

NPI: 1881431351
Provider Name (Legal Business Name): MADISON CHRISTINE KOWALSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21321 E OCOTILLO RD STE 133-134
QUEEN CREEK AZ
85142-5996
US

IV. Provider business mailing address

21321 E OCOTILLO RD STE 133-134
QUEEN CREEK AZ
85142-5996
US

V. Phone/Fax

Practice location:
  • Phone: 480-987-5525
  • Fax: 480-987-5115
Mailing address:
  • Phone: 480-987-5525
  • Fax: 480-987-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10446
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: