MEDICARE: EDMUND NOWICKI 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	207Q00000X	Family Medicine Physician	6193A	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	308483	OTHER	WY	BCBS

General Provider Information

NPI Number	:	1902801897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMUND NOWICKI MD

Provider Business Mailing Address
First Line	:	7100 COMMERCE WAY
Second Line	:	SUITE 180
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2829
Country	:	US
Telephone Number	:	615-465-7000
Fax Number	:	615-309-3338

Provider Business Practice Location Address
First Line	:	196 ARROWHEAD DR
Second Line	:	STE 1
City	:	EVANSTON
State	:	WY
Zip	:	82930-8752
Country	:	US
Telephone Number	:	877-892-9701
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	02/27/2008

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Directions to “ EDMUND NOWICKI MD” Practice Location

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