Healthcare Provider Details

I. General information

NPI: 1548520711
Provider Name (Legal Business Name): LEAH MARIE NOVAK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11475 ROBINSON DR NW
COON RAPIDS MN
55433-3746
US

IV. Provider business mailing address

1057 151ST AVE NW
ANDOVER MN
55304-7572
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-9000
  • Fax: 763-587-9130
Mailing address:
  • Phone: 763-760-4701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56667
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: