Healthcare Provider Details

I. General information

NPI: 1851301352
Provider Name (Legal Business Name): PETER D KOWYNIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43211 DALCOMA STE 7
CLINTON TWP MI
48038
US

IV. Provider business mailing address

43211 DALCOMA STE 7
CLINTON TWP MI
48038
US

V. Phone/Fax

Practice location:
  • Phone: 586-286-8800
  • Fax: 586-286-8068
Mailing address:
  • Phone: 586-286-8800
  • Fax: 586-286-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301051240
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: