Provider Demographics
NPI:1770619488
Name:WILLIAM E. NOWAK, D.O.
Entity type:Organization
Organization Name:WILLIAM E. NOWAK, D.O.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-938-2366
Mailing Address - Street 1:PO BOX 1739
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:MI
Mailing Address - Zip Code:49610-1739
Mailing Address - Country:US
Mailing Address - Phone:231-938-2366
Mailing Address - Fax:231-938-5841
Practice Address - Street 1:3990 EAST M72
Practice Address - Street 2:
Practice Address - City:ACME
Practice Address - State:MI
Practice Address - Zip Code:49610-1739
Practice Address - Country:US
Practice Address - Phone:231-938-2366
Practice Address - Fax:231-938-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWN007303207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1435577Medicaid
MIE37522Medicare UPIN
MI1435577Medicaid