Healthcare Provider Details

I. General information

NPI: 1861594509
Provider Name (Legal Business Name): NOLAN SAKOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 JETT DR
JACKSON KY
41339-9622
US

IV. Provider business mailing address

PO BOX 4342
HORSESHOE BAY TX
78657-4342
US

V. Phone/Fax

Practice location:
  • Phone: 606-666-6000
  • Fax:
Mailing address:
  • Phone: 830-598-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number25501
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25501
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: