Healthcare Provider Details

I. General information

NPI: 1801418561
Provider Name (Legal Business Name): JAMES PAUL KOWALSKI FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E ILLINOIS ST UNIT 5106
CHICAGO IL
60611-5371
US

IV. Provider business mailing address

445 E ILLINOIS ST UNIT 5106
CHICAGO IL
60611-5371
US

V. Phone/Fax

Practice location:
  • Phone: 217-619-6042
  • Fax:
Mailing address:
  • Phone: 217-619-6042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021284
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: