Healthcare Provider Details

I. General information

NPI: 1063426757
Provider Name (Legal Business Name): STEVEN WAYNE KOWALSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2128 W JEFFERSON AVE
TRENTON MI
48183
US

IV. Provider business mailing address

4501 STRANDWYCK RD
WEST BLOOMFIELD MI
48322-2233
US

V. Phone/Fax

Practice location:
  • Phone: 734-676-4040
  • Fax: 734-676-9897
Mailing address:
  • Phone: 248-703-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301042449
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: