Provider Demographics
NPI:1629351218
Name:NOWLIN SURGICAL, PC
Entity Type:Organization
Organization Name:NOWLIN SURGICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:NOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-464-2218
Mailing Address - Street 1:1200 ROOSEVELT PL
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3707
Mailing Address - Country:US
Mailing Address - Phone:219-464-2218
Mailing Address - Fax:219-477-4131
Practice Address - Street 1:1200 ROOSEVELT PLACE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:47383-3707
Practice Address - Country:US
Practice Address - Phone:219-464-2218
Practice Address - Fax:219-477-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022552B208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100160080AMedicaid
IN100160080AMedicaid