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1740282797

NPI Code Detail

MEDICARE: DR. PAUL VICTOR KOWALSKI MD

MEDICARE: DR. PAUL VICTOR 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	207W00000X	Ophthalmology Physician	053472	GA
2	207W00000X	Ophthalmology Physician	200301373	NC
3	207W00000X	Ophthalmology Physician	036079360	IL
4	207W00000X	Ophthalmology Physician	336042367	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00395184	OTHER		RR MEDICARE PROV. NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141F1	OTHER	NC	BCBS PROV #
2	33079	OTHER		OPTICARE PROVIDER NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	807073	OTHER	NC	PARTNERS PROV NUMBER

General Provider Information

NPI Number	:	1740282797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL VICTOR KOWALSKI MD

Provider Business Mailing Address
First Line	:	2020 W ILES AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-7015
Country	:	US
Telephone Number	:	217-698-3030
Fax Number	:	217-698-3068

Provider Business Practice Location Address
First Line	:	2000 W MORTON AVE
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2623
Country	:	US
Telephone Number	:	217-245-6814
Fax Number	:	217-245-0375

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	02/03/2016

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Directions to “ DR. PAUL VICTOR KOWALSKI MD” Practice Location

Language	Start Address	Practice Location

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