Healthcare Provider Details

I. General information

NPI: 1316285612
Provider Name (Legal Business Name): MICHAEL A KOWALSKI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 MCCRACKEN RD
GARFIELD HEIGHTS OH
44125-2914
US

IV. Provider business mailing address

12300 MCCRACKEN RD
GARFIELD HEIGHTS OH
44125-2914
US

V. Phone/Fax

Practice location:
  • Phone: 216-581-0500
  • Fax:
Mailing address:
  • Phone: 216-581-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number14220-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: