Provider Demographics
NPI:1629008206
Name:NOWAK, DARIN
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:NOWAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 HUNTERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-9259
Mailing Address - Country:US
Mailing Address - Phone:810-571-0556
Mailing Address - Fax:810-245-8576
Practice Address - Street 1:555 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1517
Practice Address - Country:US
Practice Address - Phone:810-966-4841
Practice Address - Fax:810-966-7927
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-09-05
Deactivation Date:2007-07-27
Deactivation Code:
Reactivation Date:2007-09-05
Provider Licenses
StateLicense IDTaxonomies
MI5501009669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P07760Medicare ID - Type UnspecifiedGROUP
MIP07760001Medicare ID - Type UnspecifiedINDIVIDUAL