Individual
DR. PAUL VICTOR KOWALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2000 W MORTON AVE, JACKSONVILLE, IL 62650-2623
(217) 245-6814
(217) 245-0375
Mailing address
2020 W ILES AVE, SPRINGFIELD, IL 62704-7015
(217) 698-3030
(217) 698-3068
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036079360
IL
207W00000X
Ophthalmology Physician
053472
GA
207W00000X
Ophthalmology Physician
200301373
NC
207W00000X
Ophthalmology Physician
336042367
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141F1
BCBS PROV #
NC
01
—
33079
OPTICARE PROVIDER NUMBER
—
05
—
5902639
—
NC
01
—
807073
PARTNERS PROV NUMBER
NC
01
—
P00395184
RR MEDICARE PROV. NUMBER
—
Enumeration date
06/02/2005
Last updated
02/03/2016
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