Healthcare Provider Details

I. General information

NPI: 1881779692
Provider Name (Legal Business Name): JOLANTA KOWALEWSKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 NE 97TH ST STE 600
OKLAHOMA CITY OK
73114-6302
US

IV. Provider business mailing address

14275 MIDWAY RD STE 400
ADDISON TX
75001-3614
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-2061
  • Fax:
Mailing address:
  • Phone:
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD00041251
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: