Provider Demographics
NPI:1063272151
Name:KOWALSKE, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:KOWALSKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9053 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-2749
Mailing Address - Country:US
Mailing Address - Phone:313-588-5283
Mailing Address - Fax:
Practice Address - Street 1:9053 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-2749
Practice Address - Country:US
Practice Address - Phone:313-588-5283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant