Provider Demographics
NPI:1619256534
Name:NOWAK, WALDEMAR (MD)
Entity Type:Individual
Prefix:
First Name:WALDEMAR
Middle Name:
Last Name:NOWAK
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 1:2272 95TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8944
Mailing Address - Country:US
Mailing Address - Phone:708-665-2118
Mailing Address - Fax:708-665-2035
Practice Address - Street 1:24600 W 127TH ST # 205
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9507
Practice Address - Country:US
Practice Address - Phone:815-731-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-93092084N0400X
FLME1377432084N0400X, 208M00000X
IAMD-426582084N0400X
IL036.1423882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist