Healthcare Provider Details

I. General information

NPI: 1225957707
Provider Name (Legal Business Name): PRAESIDIUM MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 21ST ST STE 400A
LINCOLN NE
68510-1044
US

IV. Provider business mailing address

9661 HEATHER LN
MANHATTAN KS
66502-1884
US

V. Phone/Fax

Practice location:
  • Phone: 816-668-8771
  • Fax:
Mailing address:
  • Phone: 816-668-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT JAMES NOVAK
Title or Position: PHYSICIAN
Credential: DO
Phone: 816-668-8771