Healthcare Provider Details

I. General information

NPI: 1477870459
Provider Name (Legal Business Name): JOHN PAUL KOWALCZYK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 MILITARY TRL SUITE 204
JUPITER FL
33458-4839
US

IV. Provider business mailing address

335 S BISCAYNE BLVD UNIT 3309
MIAMI FL
33131-2360
US

V. Phone/Fax

Practice location:
  • Phone: 561-296-1122
  • Fax: 561-296-5566
Mailing address:
  • Phone: 954-695-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME118694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: