Healthcare Provider Details

I. General information

NPI: 1518235787
Provider Name (Legal Business Name): RICHARD EDWARD KOWALSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW 87TH AVE SUITE B250
MIAMI FL
33173-3570
US

IV. Provider business mailing address

7800 SW 87TH AVE SUITE B250
MIAMI FL
33173-3570
US

V. Phone/Fax

Practice location:
  • Phone: 305-270-0576
  • Fax: 305-270-9496
Mailing address:
  • Phone: 305-270-0576
  • Fax: 305-270-9496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME26716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: