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NPI Code Detail

MEDICARE: MICHAEL J NOWAK PA

MEDICARE:   MICHAEL J NOWAK  PA
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
1363A00000XPhysician Assistant10410MN
2363AS0400XSurgical Physician Assistant1692WI
3363A00000XPhysician Assistant3305TN

Other Identifiers

General Provider Information

NPI Number : 1811991359
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL J NOWAK PA
Provider Business Mailing Address
First Line : 1932 ALCOA HWY
Second Line : STE 270
City : KNOXVILLE
State : TN
Zip : 37920-1537
Country : US
Telephone Number : 865-251-4658
Fax Number : 865-251-4659
Provider Business Practice Location Address
First Line : 1932 ALCOA HWY STE 270
Second Line :
City : KNOXVILLE
State : TN
Zip : 37920-1537
Country : US
Telephone Number : 865-251-4658
Fax Number : 865-251-4659
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 02/13/2018

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Directions to “ MICHAEL J NOWAK PA” Practice Location

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