Healthcare Provider Details

I. General information

NPI: 1033272943
Provider Name (Legal Business Name): MARIE NOWAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE RINCHAK

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E 1ST ST
DIXON IL
61021-3116
US

IV. Provider business mailing address

403 E 1ST ST
DIXON IL
61021-3116
US

V. Phone/Fax

Practice location:
  • Phone: 815-288-5531
  • Fax: 815-285-5558
Mailing address:
  • Phone: 815-288-5531
  • Fax: 815-285-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01041237A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number49347
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number26965
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036076143
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: