Provider Demographics
NPI:1215275623
Name:KOWAL, IZABELA (MD)
Entity type:Individual
Prefix:
First Name:IZABELA
Middle Name:
Last Name:KOWAL
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 1:1460 BELTREES ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-8353
Mailing Address - Country:US
Mailing Address - Phone:727-736-5120
Mailing Address - Fax:727-734-3653
Practice Address - Street 1:1460 BELTREES ST STE 1
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698
Practice Address - Country:US
Practice Address - Phone:727-736-5120
Practice Address - Fax:727-734-3653
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120095207R00000X
282NC0060X
NY271598207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013039800Medicaid
FLHY151YOtherMEDICARE PTAN