Provider Demographics
NPI:1063426757
Name:KOWALSKY, STEVEN WAYNE (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:KOWALSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 STRANDWYCK RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2233
Mailing Address - Country:US
Mailing Address - Phone:248-703-9000
Mailing Address - Fax:
Practice Address - Street 1:2128 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183
Practice Address - Country:US
Practice Address - Phone:734-676-4040
Practice Address - Fax:734-676-9897
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042449208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI58597-COtherHAP
MIP49287OtherBLUE CARE NETWORK
MI0E06273OtherBCBSM
MI3408231081OtherBCBS
MI1563890 TYPE 10Medicaid
MICB9133OtherRAILROAD MEDICARE
MI1563890 TYPE 10Medicaid
MI58597-COtherHAP
MI0E06273Medicare PIN