MEDICARE: DIANA LYNN NOVAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	4301076485	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11301109	OTHER		CAQH

General Provider Information

NPI Number	:	1053362186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA LYNN NOVAK MD

Provider Business Mailing Address
First Line	:	3960 W ROYAL DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-9200
Country	:	US
Telephone Number	:	231-947-0404
Fax Number	:	231-947-2190

Provider Business Practice Location Address
First Line	:	3960 W ROYAL DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-9200
Country	:	US
Telephone Number	:	231-947-0404
Fax Number	:	231-947-2190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	08/08/2025

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Directions to “ DIANA LYNN NOVAK MD” Practice Location

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