Healthcare Provider Details

I. General information

NPI: 1730298993
Provider Name (Legal Business Name): RONALD L KOWLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 S GIBSON ST
MEDFORD WI
54451-1622
US

IV. Provider business mailing address

3000 WESTHILL DR SUITE 303
WAUSAU WI
54401-3795
US

V. Phone/Fax

Practice location:
  • Phone: 715-748-2121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number22713
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: