Healthcare Provider Details

I. General information

NPI: 1275797607
Provider Name (Legal Business Name): KOWALS PEDIATRICS, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 GIRARD ST
BELLINGHAM WA
98225-4004
US

IV. Provider business mailing address

412 GIRARD ST
BELLINGHAM WA
98225-4004
US

V. Phone/Fax

Practice location:
  • Phone: 360-738-7290
  • Fax: 360-738-4832
Mailing address:
  • Phone: 360-738-7290
  • Fax: 360-738-4832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00043293
License Number StateWA

VIII. Authorized Official

Name: DR. DANIEL W KOWALS
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 360-738-7290