MEDICARE: KATIE ANN KOWALEK 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	208000000X	Pediatrics Physician	A134860	CA
2	2080P0203X	Pediatric Critical Care Medicine Physician	A134860	CA
3	208000000X	Pediatrics Physician	R72809	AZ

General Provider Information

NPI Number	:	1376830497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE ANN KOWALEK M.D.

Provider Business Mailing Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-0001
Country	:	US
Telephone Number	:	520-626-6691
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 4TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2351
Country	:	US
Telephone Number	:	415-476-5153
Fax Number	:	415-476-5354

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

Provider Enumeration Date	:	07/10/2011
Last Update Date	:	01/15/2026

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