MEDICARE: IAN J KOWALSKI, DO, PA

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1851955876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IAN J KOWALSKI, DO, PA

Provider Business Mailing Address
First Line	:	PO BOX 267545
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-7545
Country	:	US
Telephone Number	:	954-300-7688
Fax Number	:

Provider Business Practice Location Address
First Line	:	6816 GRIFFIN RD
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-4341
Country	:	US
Telephone Number	:	786-864-0425
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, FOUNDER
Name	:	DR. IAN KOWALSKI
Credential	:	DO
Telephone Number	:	954-300-7688

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	03/12/2026

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