Provider Demographics
NPI:1184671943
Name:NOWICKI, TADEUSZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:TADEUSZ
Middle Name:A
Last Name:NOWICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 WINTER GARDEN VINELAND RD STE 207
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6098
Mailing Address - Country:US
Mailing Address - Phone:407-635-3280
Mailing Address - Fax:407-636-7853
Practice Address - Street 1:5151 WINTER GARDEN VINELAND RD STE 207
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6098
Practice Address - Country:US
Practice Address - Phone:407-635-3280
Practice Address - Fax:407-636-7853
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59685208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058629300Medicaid
FL15028OtherBCBS