MEDICARE: JERILYN MICHELLE NOVA 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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	01099922A	IN

General Provider Information

NPI Number	:	1881199487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERILYN MICHELLE NOVA MD

Provider Business Mailing Address
First Line	:	PO BOX 719094
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-9318
Country	:	US
Telephone Number	:	317-777-6435
Fax Number	:	317-777-6644

Provider Business Practice Location Address
First Line	:	575 RILEY HOSPITAL DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5272
Country	:	US
Telephone Number	:	317-948-5450
Fax Number	:	317-777-6644

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

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	06/14/2026

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