MEDICARE: MRS. ELEONORA NOVIK L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	1113	MN

General Provider Information

NPI Number	:	1023318243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELEONORA NOVIK L.AC.

Provider Business Mailing Address
First Line	:	4331 EXCELSIOR BLVD
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-4811
Country	:	US
Telephone Number	:	612-306-4957
Fax Number	:	952-929-6868

Provider Business Practice Location Address
First Line	:	4331 EXCELSIOR BLVD
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-4811
Country	:	US
Telephone Number	:	612-306-4957
Fax Number	:	952-929-6868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2010
Last Update Date	:	10/22/2010

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