Provider Demographics
NPI:1093993628
Name:DR. IRA J. KOWAL M.D. P.C.
Entity Type:Organization
Organization Name:DR. IRA J. KOWAL M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-788-6678
Mailing Address - Street 1:499 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2780
Mailing Address - Country:US
Mailing Address - Phone:303-788-6678
Mailing Address - Fax:303-788-6620
Practice Address - Street 1:499 E HAMPDEN AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2780
Practice Address - Country:US
Practice Address - Phone:303-788-6678
Practice Address - Fax:303-788-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16373207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01163732Medicaid
CO811669Medicare PIN
COD23052Medicare UPIN
COC91074Medicare PIN
COC811670Medicare PIN