Healthcare Provider Details

I. General information

NPI: 1558412536
Provider Name (Legal Business Name): ROBERTA NOVAKOVIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN NOVAKOVIC MD

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390-7201
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberM5858
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberM5858
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberM5858
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberM5858
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: