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Individual

DUSTIN G NOWACEK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
819 N SHIAWASSEE ST STE 110, OWOSSO, MI 48867-1601
(989) 723-1390
(989) 725-1415
Mailing address
819 N SHIAWASSEE ST STE 110, OWOSSO, MI 48867-1601
(989) 723-1390
(989) 725-1415

Taxonomy

Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
4301092655
MI
207T00000X
Neurological Surgery Physician
4301092655
MI
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
4301092655
MI
2084N0400X
Neurology Physician
Primary
4301092655
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1699934604
MI
Enumeration date
06/04/2008
Last updated
11/30/2023
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