MEDICARE: ARTHUR NOWAK DDS

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	122300000X	Dentist	019024020	IL

General Provider Information

NPI Number	:	1639574486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARTHUR NOWAK DDS

Provider Business Mailing Address
First Line	:	7809 W SEMINOLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7809 W SEMINOLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3331
Country	:	US
Telephone Number	:	773-715-8835
Fax Number	:

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

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	10/22/2014

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