Provider Demographics
NPI:1659476265
Name:NOWAKOWSKI, BOGDAN LESZEK (MD)
Entity type:Individual
Prefix:MR
First Name:BOGDAN
Middle Name:LESZEK
Last Name:NOWAKOWSKI
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:P.O. BOX 400
Mailing Address - Street 2:
Mailing Address - City:BRITTANY
Mailing Address - State:LA
Mailing Address - Zip Code:70718-0400
Mailing Address - Country:US
Mailing Address - Phone:225-647-6900
Mailing Address - Fax:844-766-1659
Practice Address - Street 1:1429 E. HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-647-6900
Practice Address - Fax:844-766-1659
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12969R207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1555100Medicaid
LA7014046OtherAETNA POS/PPO
LAG1360OtherBLU CROSS 5 DIGIT
48-00155OtherUCH
LA72-1498557001OtherCIGNA
LA2215329OtherAETNA HMO
LA1555100Medicaid
LA2215329OtherAETNA HMO