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1275511156

NPI Code Detail

MEDICARE: GREGORY DANIEL NOVAK MD

MEDICARE: GREGORY DANIEL 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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	46598	MN
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	41896	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z154190	OTHER	AZ	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275511156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY DANIEL NOVAK MD

Provider Business Mailing Address
First Line	:	1625 N CAMPBELL AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-4330
Country	:	US
Telephone Number	:	520-626-2219
Fax Number	:	520-626-2521

Provider Business Practice Location Address
First Line	:	1625 N CAMPBELL AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-4330
Country	:	US
Telephone Number	:	520-626-2219
Fax Number	:	520-626-2521

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	05/08/2026

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Directions to “ GREGORY DANIEL NOVAK MD” Practice Location

Language	Start Address	Practice Location

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