Provider Demographics
NPI:1003298720
Name:NOWALK, NATHAN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:CHARLES
Last Name:NOWALK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT OF GME ROOM J-141
Mailing Address - Street 2:5841 S MARYLAND AVENUE MC 105
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF GME ROOM J-141
Practice Address - Street 2:5841 S MARYLAND AVENUE MC 105
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:850-624-4346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036152140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine