Healthcare Provider Details

I. General information

NPI: 1053382226
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL KOWALSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 DUBOIS DR
WARSAW IN
46580-3212
US

IV. Provider business mailing address

6920 POINTE INVERNESS WAY STE 200
FORT WAYNE IN
46804-7934
US

V. Phone/Fax

Practice location:
  • Phone: 574-371-2625
  • Fax: 260-479-2904
Mailing address:
  • Phone: 260-479-3513
  • Fax: 260-479-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01045128
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: