Provider Demographics
NPI:1497280499
Name:KOWAL, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KOWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 TROY CENTER DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4753
Mailing Address - Country:US
Mailing Address - Phone:248-459-1560
Mailing Address - Fax:
Practice Address - Street 1:2701 TROY CENTER DR
Practice Address - Street 2:SUITE 440
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4753
Practice Address - Country:US
Practice Address - Phone:248-459-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide