Healthcare Provider Details

I. General information

NPI: 1962494013
Provider Name (Legal Business Name): ANNA T KOWALSKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 WESTPARK WAY #123
EULESS TX
76040-3964
US

IV. Provider business mailing address

350 WESTPARK WAY #123
EULESS TX
76040-3964
US

V. Phone/Fax

Practice location:
  • Phone: 817-267-3065
  • Fax: 817-545-9097
Mailing address:
  • Phone: 817-267-3065
  • Fax: 817-545-9097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ0559
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: