Healthcare Provider Details

I. General information

NPI: 1871948059
Provider Name (Legal Business Name): SYLWIA NOWAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 STATE ROUTE 91 STE 330
PEORIA IL
61615-7835
US

IV. Provider business mailing address

8600 STATE ROUTE 91 STE 330
PEORIA IL
61615-7835
US

V. Phone/Fax

Practice location:
  • Phone: 309-308-2010
  • Fax: 309-308-2029
Mailing address:
  • Phone: 309-308-2010
  • Fax: 309-308-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036.148706
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.148706
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036.148706
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: