Healthcare Provider Details

I. General information

NPI: 1104822790
Provider Name (Legal Business Name): MARK FRANK KOWALSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 S RANCHO SAHUARITA BLVD # 220
SAHUARITA AZ
85629-0047
US

IV. Provider business mailing address

16260 S RANCHO SAHUARITA BLVD # 220
SAHUARITA AZ
85629-0047
US

V. Phone/Fax

Practice location:
  • Phone: 520-352-1004
  • Fax: 520-648-4343
Mailing address:
  • Phone: 520-352-1004
  • Fax: 520-648-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberHI505
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR4C36
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number13864
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number62948
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: