Provider Demographics
NPI:1619372299
Name:ANDREA NOWAK MD PC
Entity Type:Organization
Organization Name:ANDREA NOWAK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-205-5940
Mailing Address - Street 1:409 PLYMOUTH RD STE 126
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4080
Mailing Address - Country:US
Mailing Address - Phone:734-404-7002
Mailing Address - Fax:734-468-0465
Practice Address - Street 1:409 PLYMOUTH RD STE 126
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4080
Practice Address - Country:US
Practice Address - Phone:734-404-7002
Practice Address - Fax:734-468-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-25
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty