Healthcare Provider Details

I. General information

NPI: 1871554618
Provider Name (Legal Business Name): ASSOCIATES IN GENRAL & VASCULAR SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BARKLEY CR
FORT MYERS FL
33907
US

IV. Provider business mailing address

21 BARKLEY CR
FORT MYERS FL
33907
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-2616
  • Fax: 239-939-9093
Mailing address:
  • Phone: 239-939-2616
  • Fax: 239-939-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS E KOWALSKY
Title or Position: PRESIDENT
Credential: MD
Phone: 239-939-2616