Healthcare Provider Details

I. General information

NPI: 1013909332
Provider Name (Legal Business Name): CATHERINE NINA KOWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date: 03/27/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

1855 VETERANS PARK DR SUITE 103
NAPLES FL
34109-0446
US

IV. Provider business mailing address

1855 VETERANS PARK DR SUITE 103
NAPLES FL
34109-0446
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-5220
  • Fax: 239-643-9816
Mailing address:
  • Phone: 239-596-5220
  • Fax: 239-643-9816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME62925
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: