Healthcare Provider Details

I. General information

NPI: 1194735902
Provider Name (Legal Business Name): WILLIAM F. NOWLIN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ROOSEVELT PL
VALPARAISO IN
46383-3707
US

IV. Provider business mailing address

1200 ROOSEVELT PL
VALPARAISO IN
46383-3707
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-2218
  • Fax: 219-477-4131
Mailing address:
  • Phone: 219-464-2218
  • Fax: 219-477-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number22552
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: