Individual
PHILIP DANIEL NOWICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
35 MICHIGAN ST NE, SUITE 4150, GRAND RAPIDS, MI 49503-2514
(616) 267-2600
(616) 267-2601
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
4301093641
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0390297
BCBS
MI
05
—
1366608986
—
MI
Enumeration date
08/04/2008
Last updated
02/24/2021
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