Healthcare Provider Details

I. General information

NPI: 1346488756
Provider Name (Legal Business Name): MICHAEL KOWALSKI A.P., DR. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 SOUTHSIDE BLVD STE 302
JACKSONVILLE FL
32216-5488
US

IV. Provider business mailing address

4540 SOUTHSIDE BLVD STE 302
JACKSONVILLE FL
32216-5488
US

V. Phone/Fax

Practice location:
  • Phone: 904-703-6211
  • Fax: 904-296-9547
Mailing address:
  • Phone: 904-703-6211
  • Fax: 904-296-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: