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General NPI Number Information
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NPI Number | 1700398096
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Entity Type | Organization
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Legal Business Name | NOVU DERMATOLOGY & INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 929 N US HIGHWAY 441 STE 603
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City | LADY LAKE
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State | FL
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Zip | 32159-3003
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Country | US
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Telephone | 407-216-3888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2420
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City | WINDERMERE
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State | FL
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Zip | 34786-2420
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Country | US
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Telephone | 352-775-3565
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Fax | 352-633-3704
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MIGDALIA SANES
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Credential |
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Telephone | 352-427-3882
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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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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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