MEDICARE: JASON ERIC NOWAK 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	207R00000X	Internal Medicine Physician	48002	MN

General Provider Information

NPI Number	:	1437107539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ERIC NOWAK MD

Provider Business Mailing Address
First Line	:	3305 CENTRAL PARK VILLAGE DR STE 200
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55121-7707
Country	:	US
Telephone Number	:	651-406-8860
Fax Number	:	651-688-7864

Provider Business Practice Location Address
First Line	:	3305 CENTRAL PARK VILLAGE DR STE 200
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55121-7707
Country	:	US
Telephone Number	:	651-406-8860
Fax Number	:	651-688-7864

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	09/20/2018

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