Healthcare Provider Details

I. General information

NPI: 1033163944
Provider Name (Legal Business Name): THOMAS M KOWALAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3669 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

IV. Provider business mailing address

2530 E RIVER RD
GRAND ISLAND NY
14072-2193
US

V. Phone/Fax

Practice location:
  • Phone: 716-688-2154
  • Fax: 716-204-4501
Mailing address:
  • Phone: 716-775-9247
  • Fax: 716-775-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number180089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: