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General NPI Number Information
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NPI Number | 1093888182
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Entity Type | Organization
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Legal Business Name | MICHAEL NOVAK, M.D., INC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 633 N CENTRAL AVE SUITE 305
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City | GLENDALE
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State | CA
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Zip | 91203-1801
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Country | US
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Telephone | 818-244-7281
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Fax | 818-244-5912
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Provider Business Mailing Address
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Address Line | 633 N CENTRAL AVE SUITE 305
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City | GLENDALE
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State | CA
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Zip | 91203-1801
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Country | US
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Telephone | 818-244-7281
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Fax | 818-244-5912
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL NOVAK
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Credential | M.D.
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Telephone | 818-244-7281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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