Provider Demographics
NPI:1043530025
Name:KOWAL, MICHAEL VINCENT (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:KOWAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 N LAKE SHORE DR
Mailing Address - Street 2:UNIT 2311
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3400
Mailing Address - Country:US
Mailing Address - Phone:847-204-0690
Mailing Address - Fax:
Practice Address - Street 1:3801 SPRING STREET
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405
Practice Address - Country:US
Practice Address - Phone:262-687-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61558-21207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine