Provider Demographics
NPI:1265452601
Name:NOWAK, BOGNA MALGORZATA (MD)
Entity Type:Individual
Prefix:
First Name:BOGNA
Middle Name:MALGORZATA
Last Name:NOWAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S DOBSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5680
Mailing Address - Country:US
Mailing Address - Phone:480-899-7546
Mailing Address - Fax:480-899-7599
Practice Address - Street 1:725 S DOBSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5680
Practice Address - Country:US
Practice Address - Phone:480-899-7546
Practice Address - Fax:480-899-7599
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE86067Medicare UPIN
73143Medicare ID - Type Unspecified