Provider Demographics
NPI:1346488756
Name:KOWALSKI, MICHAEL (AP, DR AC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:AP, DR AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 SOUTHSIDE BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5488
Mailing Address - Country:US
Mailing Address - Phone:904-703-6211
Mailing Address - Fax:904-296-9547
Practice Address - Street 1:4540 SOUTHSIDE BLVD STE 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5488
Practice Address - Country:US
Practice Address - Phone:904-703-6211
Practice Address - Fax:904-296-9547
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist