Healthcare Provider Details

I. General information

NPI: 1457316036
Provider Name (Legal Business Name): THOMAS E KOWALSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 RIVERWALK PARK BLVD STE 100
FORT MYERS FL
33919-8758
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9960
  • Fax: 239-343-9977
Mailing address:
  • Phone: 239-343-9960
  • Fax: 239-343-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME0048210
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME0048210
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: