Provider Demographics
NPI:1740215995
Name:KOWALEWSKI, DONALD CHARLES JR (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CHARLES
Last Name:KOWALEWSKI
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2200 BERGQUIST DR
Mailing Address - Street 2:STE #1
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9907
Mailing Address - Country:US
Mailing Address - Phone:210-292-3428
Mailing Address - Fax:210-292-6141
Practice Address - Street 1:2200 BERGQUIST DR
Practice Address - Street 2:STE #1
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-9907
Practice Address - Country:US
Practice Address - Phone:210-292-3428
Practice Address - Fax:210-292-6141
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS13409207RC0200X
MI5101009956207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSF16387Medicare UPIN