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General NPI Number Information
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NPI Number | 1326043316
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Entity Type | Individual
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Provider Name | EDMUND JOSEPH KOWALCHICK JR. DPM
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 44250 GARFIELD RD STE 160
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1150
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Country | US
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Telephone | 586-228-2255
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Fax | 586-228-2740
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Provider Business Mailing Address
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Address Line | 44250 GARFIELD RD STE 160
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1150
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Country | US
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Telephone | 586-228-2255
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Fax | 586-228-2740
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | EK001446
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901001446
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License Number State | MI
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