Healthcare Provider Details

I. General information

NPI: 1376830497
Provider Name (Legal Business Name): KATIE ANN KOWALEK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2011
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

1501 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5153
  • Fax: 415-476-5354
Mailing address:
  • Phone: 520-626-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA134860
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA134860
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR72809
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: