MEDICARE: NOLAN WINSLOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	125.068677	IL
2	207T00000X	Neurological Surgery Physician	E-18933	AR

General Provider Information

NPI Number	:	1700235280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOLAN WINSLOW M.D.

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:	479-338-3720
Fax Number	:	479-338-3749

Provider Business Practice Location Address
First Line	:	2708 S RIFE MEDICAL LN STE 140
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1455
Country	:	US
Telephone Number	:	479-338-3720
Fax Number	:	479-338-3749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	07/23/2025

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