Individual
TERESA D KOWALCZYK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4221 RIDGECREST RD, SUITE 109, GREENVILLE, TX 75402-6005
(903) 455-9582
(903) 455-5689
Mailing address
4221 RIDGECREST, SUITE 109, GREENVILLE, TX 75402
(903) 455-9582
(903) 455-5689
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
K4932
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
752941533
TAX IDENTIFICATION NUMBER
TX
Enumeration date
08/10/2006
Last updated
07/08/2007
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