Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 4301054864 | MI |
N | 207VE0102X | Reproductive Endocrinologist | CK 054864 | MI |
NPI | 1053472027 |
---|---|
Provider Name | Mrs. Carole L Kowalczyk |
First Address | Warren, MI 48092 |
Second Address | Warren, MI 48092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 09/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F64872 | (02) |