MEDICARE: MATTHEW WILLIAM NOVAK 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	213ES0103X	Foot & Ankle Surgery Podiatrist	36.004196	OH

General Provider Information

NPI Number	:	1932849809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WILLIAM NOVAK DPM

Provider Business Mailing Address
First Line	:	PO BOX 25592
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-6951
Country	:	US
Telephone Number	:	708-424-3201
Fax Number	:	708-424-5001

Provider Business Practice Location Address
First Line	:	3035 HAMILTON MASON RD STE 105
Second Line	:
City	:	FAIRFIELD TOWNSHIP
State	:	OH
Zip	:	45011-5545
Country	:	US
Telephone Number	:	513-844-8585
Fax Number	:	513-844-8769

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

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	12/02/2025

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