Basic Information
Provider Information
NPI: 1508843632
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NOWICK
FirstName: DAVID
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 455 SHERMAN ST
Address2: STE 510
City: DENVER
State: CO
PostalCode: 802034400
CountryCode: US
TelephoneNumber: 3033776825
FaxNumber: 3037800787
Practice Location
Address1: 455 SHERMAN
Address2: SUITE 510
City: DENVER
State: CO
PostalCode: 802034405
CountryCode: US
TelephoneNumber: 3033776825
FaxNumber: 3037800787
Other Information
ProviderEnumerationDate: 12/29/2005
LastUpdateDate: 01/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X39257COY Allopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
11770100005WY MEDICAID
8411343851305NE MEDICAID
350668505MT MEDICAID
2157072805NM MEDICAID
100428890A05KS MEDICAID
8797871705CO MEDICAID


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