Provider Demographics
NPI:1285855239
Name:KOWAL, MARK TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:TIMOTHY
Last Name:KOWAL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1919 LATHROP ST
Mailing Address - Street 2:STE 202
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5937
Mailing Address - Country:US
Mailing Address - Phone:907-451-5507
Mailing Address - Fax:907-451-5590
Practice Address - Street 1:1919 LATHROP ST
Practice Address - Street 2:STE 202
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5937
Practice Address - Country:US
Practice Address - Phone:907-451-5507
Practice Address - Fax:907-451-5590
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2017-01-31
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Provider Licenses
StateLicense IDTaxonomies
AK7319208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA354090Medicare UPIN