Healthcare Provider Details

I. General information

NPI: 1750722252
Provider Name (Legal Business Name): SUSAN KAY KOWALSKI CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23050 WEST RD STE 110
BROWNSTOWN TWP MI
48183-1470
US

IV. Provider business mailing address

23050 WEST RD STE 110
BROWNSTOWN TWP MI
48183-1470
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-9800
  • Fax:
Mailing address:
  • Phone: 734-671-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4704125099
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: