Provider Demographics
NPI:1972570323
Name:NOWAK, MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:NOWAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10385 IRONWOOD RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4291
Mailing Address - Country:US
Mailing Address - Phone:561-408-5100
Mailing Address - Fax:561-366-7395
Practice Address - Street 1:10385 IRONWOOD RD STE 130
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4291
Practice Address - Country:US
Practice Address - Phone:561-408-5100
Practice Address - Fax:561-366-7395
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78820207ZP0105X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47164Medicare ID - Type UnspecifiedPROVIDER NUMBER
FLE70302Medicare UPIN