Provider Demographics
NPI:1306815907
Name:NOWICKI, STEVEN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DOUGLAS
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0247
Mailing Address - Country:US
Mailing Address - Phone:601-399-6167
Mailing Address - Fax:601-399-6281
Practice Address - Street 1:1002 JEFFERSON STREET
Practice Address - Street 2:SUITE 350
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4306
Practice Address - Country:US
Practice Address - Phone:601-649-5990
Practice Address - Fax:601-425-7510
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15584207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119197Medicaid
MSG53986Medicare UPIN
MS200000264Medicare ID - Type Unspecified