Healthcare Provider Details

I. General information

NPI: 1184671943
Provider Name (Legal Business Name): TADEUSZ A NOWICKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 WINTER GARDEN VINELAND RD STE 207
WINDERMERE FL
34786-6098
US

IV. Provider business mailing address

5151 WINTER GARDEN VINELAND RD STE 207
WINDERMERE FL
34786-6098
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-3280
  • Fax: 407-636-7853
Mailing address:
  • Phone: 407-635-3280
  • Fax: 407-636-7853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME59685
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: