Provider Demographics
NPI:1326043316
Name:KOWALCHICK, EDMUND JOSEPH JR (DPM)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:JOSEPH
Last Name:KOWALCHICK
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:44250 GARFIELD RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1150
Mailing Address - Country:US
Mailing Address - Phone:586-228-2255
Mailing Address - Fax:586-228-2740
Practice Address - Street 1:44250 GARFIELD RD
Practice Address - Street 2:STE 160
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1150
Practice Address - Country:US
Practice Address - Phone:586-228-2255
Practice Address - Fax:586-228-2740
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIEK001446213E00000X
MI5901001446213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1302112002OtherCIGNA
MI4855050170OtherBLUE CARE NETWORK
MI4118378OtherAETNA
MI4616834Medicaid
MIC1995OtherMCARE
MI4616834OtherMOLINA
MIU11976OtherHEALTH ALLIANCE PLAN
MI104183OtherGREAT LAKES HEALTH PLAN
MI4855050170OtherBLUE CROSS BLUE SHIELD
MIP00141753OtherRAILROAD MEDICARE
MI102448OtherPREFERRED/CARE CHOICES
MI1221070004OtherWELLNESS
MI201094969OtherTIN
MI104183OtherGREAT LAKES HEALTH PLAN
MIC1995OtherMCARE
MIU11976Medicare UPIN
MI4616834Medicaid
MI0N94990Medicare PIN