Provider Demographics
NPI:1750030615
Name:NOWAK NEUROLOGY LLC
Entity Type:Organization
Organization Name:NOWAK NEUROLOGY LLC
Other - Org Name:NOWAK NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALDEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:708-665-2118
Mailing Address - Street 1:54 ORLAND SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3207
Mailing Address - Country:US
Mailing Address - Phone:708-665-2118
Mailing Address - Fax:
Practice Address - Street 1:2272 95TH ST STE 120
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8944
Practice Address - Country:US
Practice Address - Phone:708-665-2118
Practice Address - Fax:708-665-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-19
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty