MEDICARE: DR. TADEUSZ A NOWICKI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME59685	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	15028	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184671943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TADEUSZ A NOWICKI MD

Provider Business Mailing Address
First Line	:	5151 WINTER GARDEN VINELAND RD STE 207
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-6098
Country	:	US
Telephone Number	:	407-635-3280
Fax Number	:	407-636-7853

Provider Business Practice Location Address
First Line	:	5151 WINTER GARDEN VINELAND RD STE 207
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-6098
Country	:	US
Telephone Number	:	407-635-3280
Fax Number	:	407-636-7853

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/09/2020

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Directions to “ DR. TADEUSZ A NOWICKI MD” Practice Location

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