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General NPI Number Information
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NPI Number | 1043530025
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Entity Type | Individual
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Provider Name | MICHAEL VINCENT KOWAL D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3801 SPRING STREET
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City | RACINE
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State | WI
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Zip | 53405
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Country | US
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Telephone | 262-687-4011
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Fax |
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Provider Business Mailing Address
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Address Line | 474 N LAKE SHORE DR UNIT 2311
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City | CHICAGO
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State | IL
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Zip | 60611-3400
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Country | US
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Telephone | 847-204-0690
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 61558-21
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License Number State | WI
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