MEDICARE: DR. ANDRE J NOLEWAJKA MD; M.CL.SC

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	207RI0011X	Interventional Cardiology Physician	R2997	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	53875	OTHER		MEDICARE, ARK BC, FED BC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A002	OTHER	TRICARE
3	60014634	OTHER	TRAVELERS M/C R/R
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	119173	OTHER	DEPT OF LABOR
6	14059000040	OTHER	QUALCHOICE
7	29730300	OTHER	BLACK LUNG
8	29730300	OTHER	UMWA M/C

General Provider Information

NPI Number	:	1467456954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE J NOLEWAJKA MD; M.CL.SC

Provider Business Mailing Address
First Line	:	PO BOX 10570
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-0570
Country	:	US
Telephone Number	:	479-314-4650
Fax Number	:	479-452-9459

Provider Business Practice Location Address
First Line	:	7001 ROGERS AVE
Second Line	:	STE 401
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4073
Country	:	US
Telephone Number	:	479-314-4650
Fax Number	:	479-452-9459

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/01/2013

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