MEDICARE: DR. BRIAN NOVACK DPM

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	213E00000X	Podiatrist	36-00-2998-N	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480031313	OTHER	OH	MEDICARE RAILROAD
2	DD0381	OTHER	OH	MEDICARE RAILROAD
3	P00269217	OTHER	OH	MEDICARE RAILROAD
4	CH5179	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1598762924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN NOVACK DPM

Provider Business Mailing Address
First Line	:	29630 EUCLID AVE
Second Line	:
City	:	WICKLIFFE
State	:	OH
Zip	:	44092-1829
Country	:	US
Telephone Number	:	440-944-6665
Fax Number	:

Provider Business Practice Location Address
First Line	:	29630 EUCLID AVE
Second Line	:
City	:	WICKLIFFE
State	:	OH
Zip	:	44092-1829
Country	:	US
Telephone Number	:	440-944-6665
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	02/08/2023

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Directions to “ DR. BRIAN NOVACK DPM” Practice Location

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