Healthcare Provider Details

I. General information

NPI: 1578199329
Provider Name (Legal Business Name): ASHLEY LYNN KOWALKOWSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY LYNN STARCEVICH

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 COLD SPRING RD
INDIANAPOLIS IN
46222-1960
US

IV. Provider business mailing address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

V. Phone/Fax

Practice location:
  • Phone: 219-308-2045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101027635
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: