MEDICARE: MRS. YVETTE 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	207R00000X	Internal Medicine Physician	ME47513	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46191	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1780677559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YVETTE NOVAK MD

Provider Business Mailing Address
First Line	:	PO BOX 907
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-0907
Country	:	US
Telephone Number	:	850-837-0141
Fax Number	:	850-837-8801

Provider Business Practice Location Address
First Line	:	994 AIRPORT RD
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2820
Country	:	US
Telephone Number	:	850-837-0141
Fax Number	:	850-837-8801

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	02/27/2012

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