Doctor Name: | MR. BOONE S. KOWALIS |
NPI Number: | 1023297884 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 15752 Oakhill Ct Livonia, MI - 481542613 |
Business Phone Number: | 8004476038 |
Business Fax Number: | 7345424289 |
Mailing Address: | 15752 Oakhill Ct, LIVONIA |
State: | MI |
Postal Code: | 481542613 |
Phone Number: | 8004476038 |
Fax Number: | 7345424289 |
NPI Enumeration Date: | 10/29/2007 |
NPI Last Update Date: | 10/29/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171WH0202X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Contractor |
Taxonomy Specialization: | Home Modifications |
Taxonomy Definition: |