Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35047204 | OH |
NPI | 1003866161 |
---|---|
Provider Name | Dr. Bernard Harold Nowacki |
First Address | Columbus, OH 43260-6453 |
Second Address | Marion, OH 43302-6416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 11/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0488459 | (05) | OH |
A15136 | (02) |