Healthcare Provider Details

I. General information

NPI: 1013921857
Provider Name (Legal Business Name): ANDREA E NOWAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 PLYMOUTH RD SUITE 126
PLYMOUTH MI
48170-1497
US

IV. Provider business mailing address

409 PLYMOUTH RD SUITE 126
PLYMOUTH MI
48170-1497
US

V. Phone/Fax

Practice location:
  • Phone: 734-404-7002
  • Fax: 734-468-0465
Mailing address:
  • Phone: 734-404-7002
  • Fax: 734-468-0465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301070428
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: