Healthcare Provider Details

I. General information

NPI: 1902829005
Provider Name (Legal Business Name): ALBERT JOSEPH NOVAK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 RAND BLVD SUITE 200
SARASOTA FL
34238-5118
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-2300
  • Fax: 941-923-1453
Mailing address:
  • Phone: 941-917-8454
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS12417
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: