Provider Demographics
NPI:1194902163
Name:NOWAK, WILLIAM E (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:NOWAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 EAST M72
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:MI
Mailing Address - Zip Code:49610
Mailing Address - Country:US
Mailing Address - Phone:231-938-2366
Mailing Address - Fax:231-938-5841
Practice Address - Street 1:3990 EAST M72
Practice Address - Street 2:
Practice Address - City:ACME
Practice Address - State:MI
Practice Address - Zip Code:49690
Practice Address - Country:US
Practice Address - Phone:231-938-2366
Practice Address - Fax:231-938-5841
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWN007303207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1435577Medicaid
MI1435577Medicaid
0B86388Medicare PIN