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NPI Code Detail

MEDICARE: MICHAEL NOWACKI M.D.

MEDICARE: MICHAEL NOWACKI M.D.
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician38687KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821091273
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL NOWACKI M.D.
Provider Business Mailing Address
First Line : 2307 GREENE WAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40220-4009
Country : US
Telephone Number : 502-736-4343
Fax Number :
Provider Business Practice Location Address
First Line : 2307 GREENE WAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40220-4009
Country : US
Telephone Number : 502-897-9594
Fax Number : 502-896-1808
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 09/12/2016

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