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NPI Code Detail

MEDICARE: CHARLES S NOWAK DO

MEDICARE: CHARLES S NOWAK DO
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
1207Q00000XFamily Medicine PhysicianCO 48799CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679564058
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES S NOWAK DO
Provider Business Mailing Address
First Line : PO BOX 1727
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81502-1727
Country : US
Telephone Number : 970-263-2600
Fax Number : 970-263-2692
Provider Business Practice Location Address
First Line : 2020 N 12TH ST
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-2914
Country : US
Telephone Number : 970-644-4220
Fax Number : 970-263-4239
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 06/28/2022

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Directions to “ CHARLES S NOWAK DO” Practice Location

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