Provider Demographics
NPI:1275797607
Name:KOWALS PEDIATRICS, PS
Entity Type:Organization
Organization Name:KOWALS PEDIATRICS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:KOWALS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-738-7290
Mailing Address - Street 1:412 GIRARD ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4004
Mailing Address - Country:US
Mailing Address - Phone:360-738-7290
Mailing Address - Fax:360-738-4832
Practice Address - Street 1:412 GIRARD ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4004
Practice Address - Country:US
Practice Address - Phone:360-738-7290
Practice Address - Fax:360-738-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7140874Medicaid