Provider Demographics
NPI:1457790008
Name:NOWACEK, ARI SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:ARI
Middle Name:SCOTT
Last Name:NOWACEK
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 1:8755 W HIGGINS RD
Mailing Address - Street 2:SUITE 1025
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2708
Mailing Address - Country:US
Mailing Address - Phone:773-380-6600
Mailing Address - Fax:
Practice Address - Street 1:8755 W HIGGINS RD
Practice Address - Street 2:SUITE 1025
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2708
Practice Address - Country:US
Practice Address - Phone:773-380-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125062712207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology