Healthcare Provider Details

I. General information

NPI: 1538213269
Provider Name (Legal Business Name): JOHN R NOVOSAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 OSCEOLA ST
LAURIUM MI
49913-2134
US

IV. Provider business mailing address

205 OSCEOLA ST
LAURIUM MI
49913-2134
US

V. Phone/Fax

Practice location:
  • Phone: 906-337-6500
  • Fax: 906-337-6597
Mailing address:
  • Phone: 906-337-6500
  • Fax: 906-337-6597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301406409
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: