Provider Demographics
NPI:1104822790
Name:KOWALSKI, MARK FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:FRANK
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16260 S RANCHO SAHUARITA BLVD # 220
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-0047
Mailing Address - Country:US
Mailing Address - Phone:520-352-1004
Mailing Address - Fax:520-648-4343
Practice Address - Street 1:16260 S RANCHO SAHUARITA BLVD # 220
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-0047
Practice Address - Country:US
Practice Address - Phone:520-352-1004
Practice Address - Fax:520-648-4343
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXHI505207X00000X
MOR4C36207X00000X
OK13864207X00000X
AZ62948207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ008504Medicaid
1104822790Medicare PIN