Provider Demographics
NPI:1235178708
Name:KOWALSKI, JOHN ALLEN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W MADISON ST
Mailing Address - Street 2:UNIT 523
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1936
Mailing Address - Country:US
Mailing Address - Phone:312-666-5753
Mailing Address - Fax:
Practice Address - Street 1:2020 W HARRISON ST
Practice Address - Street 2:SUITE 1266
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3741
Practice Address - Country:US
Practice Address - Phone:312-572-4739
Practice Address - Fax:312-572-4719
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053307207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
205927Medicare ID - Type Unspecified
ILC41986Medicare UPIN