Healthcare Provider Details

I. General information

NPI: 1710091467
Provider Name (Legal Business Name): ALAN F KOWALSKI MSN NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 JOHN R ST VA MEDICAL CENTER-ORTHOPEDICS
DETROIT MI
48201-1916
US

IV. Provider business mailing address

4933 ARMONK DR
STERLING HEIGHTS MI
48310-3402
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-1000
  • Fax:
Mailing address:
  • Phone: 586-978-8196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704164232
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: