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General NPI Number Information
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NPI Number | 1558360131
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Entity Type | Individual
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Provider Name | MICHAEL L NOWAK D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 350 W COUNTRY CLUB RD STE# 203
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City | ROSWELL
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State | NM
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Zip | 88201-5205
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Country | US
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Telephone | 575-624-4646
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Fax | 575-625-8498
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Provider Business Mailing Address
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Address Line | 350 W COUNTRY CLUB RD STE# 203
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City | ROSWELL
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State | NM
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Zip | 88201-5205
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Country | US
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Telephone | 575-624-4646
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Fax | 575-625-8498
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2619
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A-1602-11
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License Number State | NM
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