Provider Demographics
NPI:1871619411
Name:NOWAK, RICHARD F (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:NOWAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W. ELLSWORTH
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-5194
Mailing Address - Country:US
Mailing Address - Phone:989-832-6734
Mailing Address - Fax:989-832-6628
Practice Address - Street 1:220 W. ELLSWORTH
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5194
Practice Address - Country:US
Practice Address - Phone:989-832-6734
Practice Address - Fax:989-832-6628
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRN0053182083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0992312OtherHEALTH PLUS
MI1849725OtherMEDICAID MIHP
MI5100706OtherMEDICAID FAMILY PLANNING
MI2842380OtherMEDICAID IMMUNIZATIONS
MI0E61006Medicare PIN