Healthcare Provider Details

I. General information

NPI: 1861546954
Provider Name (Legal Business Name): BRIAN J NOVACK DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20050 HARVARD AVE STE 105
WARRENSVILLE HEIGHTS OH
44122-6800
US

IV. Provider business mailing address

29630 EUCLID AVE
WICKLIFFE OH
44092-1829
US

V. Phone/Fax

Practice location:
  • Phone: 216-491-9151
  • Fax: 216-491-7243
Mailing address:
  • Phone: 440-944-6665
  • Fax: 440-944-6672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36-002998N
License Number StateOH

VIII. Authorized Official

Name: DR. BRIAN J NOVACK
Title or Position: PODIATRIST
Credential: DPM
Phone: 216-491-9151