Provider Demographics
NPI:1063754158
Name:KOWALSKA, ANETA MONIKA (MD)
Entity type:Individual
Prefix:MS
First Name:ANETA
Middle Name:MONIKA
Last Name:KOWALSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 BARRING TRCE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2500
Mailing Address - Country:US
Mailing Address - Phone:309-689-3030
Mailing Address - Fax:
Practice Address - Street 1:3915 BARRING TRCE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2500
Practice Address - Country:US
Practice Address - Phone:309-689-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036140009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
036140009OtherLICENSE