Provider Demographics
NPI:1205838182
Name:KOWALSKI, JOSEPH MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MARK
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81398
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-1398
Mailing Address - Country:US
Mailing Address - Phone:337-269-9777
Mailing Address - Fax:337-269-0244
Practice Address - Street 1:315 RUE LOUIS XIV
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5734
Practice Address - Country:US
Practice Address - Phone:337-269-9777
Practice Address - Fax:337-269-0244
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08396207RC0000X
LA08396R207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00377443OtherRRMC
LA1399418Medicaid
LA1399418Medicaid
5N049DU59Medicare PIN