MEDICARE: DR. ANDREW KOWALSKI M.D.

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	207RN0300X	Nephrology Physician	036137310	IL

General Provider Information

NPI Number	:	1114293123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW KOWALSKI M.D.

Provider Business Mailing Address
First Line	:	120 W 22ND ST STE 200
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1563
Country	:	US
Telephone Number	:	630-573-5000
Fax Number	:	630-491-5472

Provider Business Practice Location Address
First Line	:	2055 W ARMY TRAIL RD STE 110E
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-1478
Country	:	US
Telephone Number	:	773-284-9247
Fax Number	:	773-284-9249

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

Provider Enumeration Date	:	03/25/2012
Last Update Date	:	08/04/2025

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