Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 4301042449 | MI |
NPI | 1063426757 |
---|---|
Provider Name | Steven Wayne Kowalsky |
First Address | West Bloomfield, MI 48322-2233 |
Second Address | Trenton, MI 48183 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 24/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A76871 | (02) | MI |