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General NPI Number Information
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NPI Number | 1144224635
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Entity Type | Organization
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Legal Business Name | ANDRE J. NOLEWAJKA, MD, PA
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 2713 S 74TH ST STE 401
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City | FORT SMITH
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State | AR
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Zip | 72903-5173
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Country | US
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Telephone | 479-452-7324
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Fax | 479-452-6793
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Provider Business Mailing Address
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Address Line | PO BOX 10570
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City | FORT SMITH
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State | AR
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Zip | 72917-0570
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Country | US
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Telephone | 479-452-7324
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Fax | 479-452-6793
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDRE J NOLEWAJKA
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Credential | MD
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Telephone | 479-452-7324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MC-1345
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License Number State | AR
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