Individual
TIMOTHY B KOWALESKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1720 BEACON ST, FORT WAYNE, IN 46805-4749
(260) 373-8000
(260) 373-8034
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02004981A
IN
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
02004981A
IN
Other
Enumeration date
05/21/2015
Last updated
10/10/2022
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