Provider Demographics
NPI:1013921857
Name:NOWAK, ANDREA E (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:NOWAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 PLYMOUTH RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1497
Mailing Address - Country:US
Mailing Address - Phone:734-404-7002
Mailing Address - Fax:734-468-0465
Practice Address - Street 1:409 PLYMOUTH RD
Practice Address - Street 2:SUITE 126
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1497
Practice Address - Country:US
Practice Address - Phone:734-404-7002
Practice Address - Fax:734-468-0465
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010704282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1619372299OtherNPI FOR ANDREA NOWAK MD PC (PRIVATE PRACTICE)
MI1497865802OtherNPI FOR KARALEE & ASSOCIATES PC