Provider Demographics
NPI:1942609649
Name:CATHERINE KOWAL
Entity Type:Organization
Organization Name:CATHERINE KOWAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:NINA
Authorized Official - Last Name:KOWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-596-5220
Mailing Address - Street 1:1855 VETERANS PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0446
Mailing Address - Country:US
Mailing Address - Phone:239-596-5220
Mailing Address - Fax:239-596-5222
Practice Address - Street 1:1855 VETERANS PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0446
Practice Address - Country:US
Practice Address - Phone:239-596-5220
Practice Address - Fax:239-596-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062925207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18310AMedicare PIN