Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036152140 | IL |
Y | 111NI0900X | Internist | 036152140 | IL |
NPI | 1003298720 |
---|---|
Provider Name | Dr. Nathan Charles Nowalk |
First Address | Chicago, IL 60637 |
Second Address | Chicago, IL 60637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2015 |
Last Update Date | 02/07/2020 |