MEDICARE: DR. PATRICIA M. KOWALIK D.D.S.

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	122300000X	Dentist	019021369	IL

General Provider Information

NPI Number	:	1124103064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA M. KOWALIK D.D.S.

Provider Business Mailing Address
First Line	:	7607 NORTH AVE
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1105
Country	:	US
Telephone Number	:	708-366-6181
Fax Number	:	708-366-6445

Provider Business Practice Location Address
First Line	:	7607 NORTH AVE
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1105
Country	:	US
Telephone Number	:	708-366-6181
Fax Number	:	708-366-6445

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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