Healthcare Provider Details

I. General information

NPI: 1598389058
Provider Name (Legal Business Name): CHRISTOPHER KOWALCZYK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10075 S JOG RD STE 206
BOYNTON BEACH FL
33437-3536
US

IV. Provider business mailing address

4362 NORTHLAKE BLVD STE 114
PALM BEACH GARDENS FL
33410-6269
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-1100
  • Fax:
Mailing address:
  • Phone: 561-210-7310
  • Fax: 561-210-7250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS18772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: