Provider Demographics
NPI:1871571661
Name:NOWAK, CANDACE (DO)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:
Last Name:NOWAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-2814
Mailing Address - Country:US
Mailing Address - Phone:773-523-0400
Mailing Address - Fax:773-523-2725
Practice Address - Street 1:4455 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2814
Practice Address - Country:US
Practice Address - Phone:773-523-0400
Practice Address - Fax:773-523-2725
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15650Medicare UPIN
IL204591 - L96524Medicare PIN