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General NPI Number Information
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NPI Number | 1215972526
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Entity Type | Individual
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Provider Name | DIMITRI NOVITZKY MD
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 05/27/2019
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Provider Practice Location Address
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Address Line | 1001 N MACDILL AVE STE B
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City | TAMPA
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State | FL
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Zip | 33607
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Country | US
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Telephone | 813-675-4849
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Fax |
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Provider Business Mailing Address
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Address Line | 4407 VIEUX CARRE CIR
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City | TAMPA
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State | FL
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Zip | 33613-3052
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Country | US
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Telephone | 813-390-5344
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Fax | 386-774-1264
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | ME61367
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License Number State | FL
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