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General NPI Number Information
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NPI Number | 1376001172
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Entity Type | Organization
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Legal Business Name | LARISA KACHOWSKI, MD
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 1726 W 42D AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603-7160
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Country | US
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Telephone | 501-502-4071
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Fax |
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Provider Business Mailing Address
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Address Line | 3 STRATFORD LN
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City | PINE BLUFF
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State | AR
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Zip | 71603-7527
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Country | US
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Telephone | 501-502-4071
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LARISA KACHOWSKI
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Credential | MD
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Telephone | 501-502-4071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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