Provider Demographics
NPI:1073538534
Name:KOWATLI, ALLAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAM
Middle Name:A
Last Name:KOWATLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALLAM
Other - Middle Name:A
Other - Last Name:ALKOWATLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7 SHACKLEFORD WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3714
Mailing Address - Country:US
Mailing Address - Phone:501-664-5860
Mailing Address - Fax:501-664-0889
Practice Address - Street 1:7 SHACKLEFORD WEST BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3714
Practice Address - Country:US
Practice Address - Phone:501-664-5860
Practice Address - Fax:501-664-0889
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2545207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5L552Medicare PIN
ARF58886Medicare UPIN