Healthcare Provider Details

I. General information

NPI: 1902115868
Provider Name (Legal Business Name): AMANDA KOWALSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N STATE ROAD 7
MARGATE FL
33063-5727
US

IV. Provider business mailing address

3100 CORAL HILLS DR STE 308
CORAL SPRINGS FL
33065-4138
US

V. Phone/Fax

Practice location:
  • Phone: 954-636-2034
  • Fax:
Mailing address:
  • Phone: 954-636-2034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: