Healthcare Provider Details

I. General information

NPI: 1275628075
Provider Name (Legal Business Name): DAVID MICHAEL KOWAL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3092 PIERSON
FLINT MI
48504-6861
US

IV. Provider business mailing address

3092 PIERSON RD
FLINT MI
48504-6861
US

V. Phone/Fax

Practice location:
  • Phone: 810-789-3881
  • Fax: 810-789-3885
Mailing address:
  • Phone: 810-789-3881
  • Fax: 810-789-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number5901001427
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: