Healthcare Provider Details

I. General information

NPI: 1841485612
Provider Name (Legal Business Name): LEVI J. NOVERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 IMMOKALEE RD
NAPLES FL
34110-1424
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD KIDZ MEDICAL SERVICES, INC.
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 239-213-0690
  • Fax: 239-552-4060
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50847-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50847-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME100438
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME100438
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: