MEDICARE: DR. JAYSHREE J NOVAK MD

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	208000000X	Pediatrics Physician	K1886	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164426573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYSHREE J NOVAK MD

Provider Business Mailing Address
First Line	:	500 N COIT RD
Second Line	:	SUITE 2074
City	:	RICHARDSON
State	:	TX
Zip	:	75080-5444
Country	:	US
Telephone Number	:	972-231-4605
Fax Number	:	972-231-2731

Provider Business Practice Location Address
First Line	:	500 N COIT RD
Second Line	:	SUITE 2074
City	:	RICHARDSON
State	:	TX
Zip	:	75080-5444
Country	:	US
Telephone Number	:	972-231-4605
Fax Number	:

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/16/2020

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