Provider Demographics
NPI:1477870459
Name:KOWALCZYK, JOHN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:KOWALCZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:335 S BISCAYNE BLVD
Mailing Address - Street 2:UNIT 3309
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2360
Mailing Address - Country:US
Mailing Address - Phone:954-695-5402
Mailing Address - Fax:
Practice Address - Street 1:4495 MILITARY TRL
Practice Address - Street 2:SUITE 204
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4839
Practice Address - Country:US
Practice Address - Phone:561-296-1122
Practice Address - Fax:561-296-5566
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118694207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology