Healthcare Provider Details

I. General information

NPI: 1689744351
Provider Name (Legal Business Name): JAMES EDMUND NOVAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD, CFP-505 DIVISION OF NEPHROLOGY, HENRY FORD HEALTH SYSTEM
DETROIT MI
48202
US

IV. Provider business mailing address

2799 W GRAND BLVD, CFP-505 DIVISION OF NEPHROLOGY, HENRY FORD HEALTH SYSTEM
DETROIT MI
48202
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2710
  • Fax: 313-916-2554
Mailing address:
  • Phone: 313-916-2710
  • Fax: 313-916-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301080011
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301080011
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: