Provider Demographics
NPI:1134430051
Name:NOWAK, MARY JANE A (MD)
Entity type:Individual
Prefix:DR
First Name:MARY JANE
Middle Name:A
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 1:9540 SOUTHWEST HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2802
Mailing Address - Country:US
Mailing Address - Phone:708-636-3333
Mailing Address - Fax:
Practice Address - Street 1:9540 SOUTHWEST HWY
Practice Address - Street 2:SUITE A
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2802
Practice Address - Country:US
Practice Address - Phone:312-513-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130807207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology