Healthcare Provider Details

I. General information

NPI: 1205838182
Provider Name (Legal Business Name): JOSEPH MARK KOWALSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 RUE LOUIS XIV
LAFAYETTE LA
70508-5734
US

IV. Provider business mailing address

PO BOX 81398
LAFAYETTE LA
70598-1398
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-9777
  • Fax: 337-269-0244
Mailing address:
  • Phone: 337-269-9777
  • Fax: 337-269-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number08396
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number08396R
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number08396R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: