Healthcare Provider Details

I. General information

NPI: 1154517951
Provider Name (Legal Business Name): ANDREW JOSEPH KOWALKOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 MARIAN SQ
OAK BROOK IL
60523-2572
US

IV. Provider business mailing address

611 MARIAN SQ
OAK BROOK IL
60523-2572
US

V. Phone/Fax

Practice location:
  • Phone: 630-632-2632
  • Fax: 630-654-2327
Mailing address:
  • Phone: 630-632-2632
  • Fax: 630-654-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: