Provider Demographics
NPI:1144224635
Name:ANDRE J. NOLEWAJKA, MD, PA
Entity Type:Organization
Organization Name:ANDRE J. NOLEWAJKA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOLEWAJKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-452-7324
Mailing Address - Street 1:PO BOX 10570
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0570
Mailing Address - Country:US
Mailing Address - Phone:479-452-7324
Mailing Address - Fax:479-452-6793
Practice Address - Street 1:2713 S 74TH ST
Practice Address - Street 2:STE 401
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5173
Practice Address - Country:US
Practice Address - Phone:479-452-7324
Practice Address - Fax:479-452-6793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-1345207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C696Medicare ID - Type Unspecified