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General NPI Number Information
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NPI Number | 1417816919
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Entity Type | Organization
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Legal Business Name | NOVALIFE MEDICAL, PLLC
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Dates
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Enumeration Date | 01/20/2026
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 1201 N LA SALLE DR APT 3011
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City | CHICAGO
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State | IL
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Zip | 60610-3053
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Country | US
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Telephone | 773-680-7011
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 N LA SALLE DR APT 3011
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City | CHICAGO
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State | IL
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Zip | 60610-3053
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Country | US
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Telephone | 773-680-7011
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | DIANA SINGH
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Credential |
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Telephone | 407-450-4491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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