Healthcare Provider Details

I. General information

NPI: 1538157706
Provider Name (Legal Business Name): IRA J KOWAL M.D. P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 E HAMPDEN AVE SUITE 250
ENGLEWOOD CO
80113-2780
US

IV. Provider business mailing address

499 E HAMPDEN AVE SUITE 250
ENGLEWOOD CO
80113-2780
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-6678
  • Fax: 303-788-6620
Mailing address:
  • Phone: 303-788-6678
  • Fax: 303-788-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number16373
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: