MEDICARE: JOANNA NOWAK MD

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	207R00000X	Internal Medicine Physician	V7975	TX

General Provider Information

NPI Number	:	1902535057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA NOWAK MD

Provider Business Mailing Address
First Line	:	1307 W LEAGUE CITY PKWY
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-6313
Country	:	US
Telephone Number	:	616-755-8619
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 W LEAGUE CITY PKWY
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-6313
Country	:	US
Telephone Number	:	616-755-8619
Fax Number	:

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

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	10/08/2025

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