Healthcare Provider Details

I. General information

NPI: 1578554424
Provider Name (Legal Business Name): PEGGYANN NOWAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 ORCHARD LAKE RD STE 314
WEST BLOOMFIELD MI
48322
US

IV. Provider business mailing address

6900 ORCHARD LAKE RD STE 314
WEST BLOOMFIELD MI
48322
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-7530
  • Fax: 248-855-5639
Mailing address:
  • Phone: 248-855-7530
  • Fax: 248-855-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301046105
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: