Healthcare Provider Details

I. General information

NPI: 1346097102
Provider Name (Legal Business Name): NOVA PHYSICIAN GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 DIXIE HWY
LOUISVILLE KY
40210-2313
US

IV. Provider business mailing address

30 W MONROE ST STE 1200
CHICAGO IL
60603
US

V. Phone/Fax

Practice location:
  • Phone: 502-444-6016
  • Fax: 502-586-7178
Mailing address:
  • Phone: 773-352-1515
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRENCE MORTON JR.
Title or Position: SR. MEDICAL DIRECTOR
Credential:
Phone: 773-733-9730