MEDICARE: LYNN D KOWALSKI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0201X	Gynecologic Oncology Physician	8628	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083613616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN D KOWALSKI MD

Provider Business Mailing Address
First Line	:	PO BOX 50634
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89016-0634
Country	:	US
Telephone Number	:	702-739-6467
Fax Number	:	702-733-1689

Provider Business Practice Location Address
First Line	:	6020 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2656
Country	:	US
Telephone Number	:	702-739-6467
Fax Number	:	702-733-1689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	05/13/2015

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