Provider Demographics
NPI:1275628075
Name:KOWAL, DAVID MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:KOWAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3092 PIERSON RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-6861
Mailing Address - Country:US
Mailing Address - Phone:810-789-3881
Mailing Address - Fax:810-789-3885
Practice Address - Street 1:3092 PIERSON
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-6861
Practice Address - Country:US
Practice Address - Phone:810-789-3881
Practice Address - Fax:810-789-3885
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001427213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI134400940Medicaid
MI2748413Medicaid
MI480033814OtherRAIL ROAD MEDICARE
MI480033814Medicaid
MIN49300003Medicare PIN
MI0B56133Medicare PIN
MIN49200003Medicare PIN
MI480033814OtherRAIL ROAD MEDICARE