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NPI Code Detail

MEDICARE: GARY J NOVETSKY M.D.

MEDICARE:   GARY J NOVETSKY  M.D.
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
12085R0202XDiagnostic Radiology PhysicianIL

General Provider Information

NPI Number : 1700879566
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY J NOVETSKY M.D.
Provider Business Mailing Address
First Line : 9600 GROSS POINT RD
Second Line : SUITE A
City : SKOKIE
State : IL
Zip : 60076-1214
Country : US
Telephone Number : 847-933-6111
Fax Number : 847-933-6113
Provider Business Practice Location Address
First Line : 9600 GROSS POINT RD
Second Line : SUITE A
City : SKOKIE
State : IL
Zip : 60076-1214
Country : US
Telephone Number : 847-933-6111
Fax Number : 847-933-6113
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2005
Last Update Date : 08/21/2007

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Directions to “ GARY J NOVETSKY M.D.” Practice Location

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