Provider Demographics
NPI:1407800774
Name:KOWALKE, KATHY JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:JOY
Last Name:KOWALKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36500 AURORA DR. SUITE 430
Mailing Address - Street 2:AURORA MEDICAL CENTER
Mailing Address - City:SUMMIT
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36500 AURORA DR. SUITE 430
Practice Address - Street 2:AURORA MEDICAL CENTER
Practice Address - City:SUMMIT
Practice Address - State:WI
Practice Address - Zip Code:53066
Practice Address - Country:US
Practice Address - Phone:414-454-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI321142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000219WOtherHUMANA
WI31746700Medicaid
002000219WOtherHUMANA
WI31746700Medicaid