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General NPI Number Information
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NPI Number | 1619372299
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Entity Type | Organization
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Legal Business Name | ANDREA NOWAK MD PC
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Dates
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Enumeration Date | 10/25/2014
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 409 PLYMOUTH RD STE 126
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City | PLYMOUTH
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State | MI
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Zip | 48170-4080
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Country | US
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Telephone | 734-404-7002
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Fax | 734-468-0465
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Provider Business Mailing Address
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Address Line | 409 PLYMOUTH RD STE 126
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City | PLYMOUTH
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State | MI
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Zip | 48170-4080
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Country | US
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Telephone | 734-404-7002
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Fax | 734-468-0465
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Authorized Official
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Title or Position | SELF
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Name | DR. ANDREA NOWAK
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Credential | MD
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Telephone | 313-205-5940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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