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NPI Code Detail

MEDICARE: DR. JEREMY NOVAK PH.D.

MEDICARE: DR. JEREMY NOVAK PH.D.
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
1103TC0700XClinical Psychologist6301012112MI

General Provider Information

NPI Number : 1184744682
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMY NOVAK PH.D.
Provider Business Mailing Address
First Line : 29750 HARPER AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48082-2607
Country : US
Telephone Number : 586-777-3200
Fax Number : 586-777-7855
Provider Business Practice Location Address
First Line : 29750 HARPER AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48082-2607
Country : US
Telephone Number : 586-777-3200
Fax Number : 586-777-7855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 11/27/2024

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