Provider Demographics
NPI:1477569606
Name:KOWALKOWSKI, THOMAS CHRISTOPHER (DO)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHRISTOPHER
Last Name:KOWALKOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CONNECTICUT AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2474
Mailing Address - Country:US
Mailing Address - Phone:320-229-1500
Mailing Address - Fax:320-229-1505
Practice Address - Street 1:2301 CONNECTICUT AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2474
Practice Address - Country:US
Practice Address - Phone:320-229-1500
Practice Address - Fax:320-229-1505
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41961208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410645800Medicaid
MN410645800Medicaid
MN090000014Medicare ID - Type Unspecified