Provider Demographics
NPI:1942305602
Name:NOWAK, THOMAS PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
Last Name:NOWAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5515
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34674-5515
Mailing Address - Country:US
Mailing Address - Phone:727-868-9563
Mailing Address - Fax:727-869-6909
Practice Address - Street 1:7315 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1158
Practice Address - Country:US
Practice Address - Phone:727-868-9563
Practice Address - Fax:727-869-6909
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59443207T00000X
FLME112041207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G594430Medicaid
CACB244232Medicare PIN
CAA53496Medicare UPIN