Provider Demographics
NPI:1609947316
Name:NOWICKI, ANDRZEJ WLODZIMIERZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRZEJ
Middle Name:WLODZIMIERZ
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 1:4600 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2247
Mailing Address - Country:US
Mailing Address - Phone:352-367-2310
Mailing Address - Fax:352-367-2512
Practice Address - Street 1:4600 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2247
Practice Address - Country:US
Practice Address - Phone:352-367-2310
Practice Address - Fax:352-367-2512
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81698207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260802200Medicaid
FL58684Medicare PIN
FL260802200Medicaid
FL58684Medicare ID - Type Unspecified