Provider Demographics
NPI:1063400703
Name:NOVAK, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:633 N CENTRAL AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1801
Mailing Address - Country:US
Mailing Address - Phone:818-244-7281
Mailing Address - Fax:818-244-5912
Practice Address - Street 1:633 N CENTRAL AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1801
Practice Address - Country:US
Practice Address - Phone:818-244-7281
Practice Address - Fax:818-244-5912
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG8405207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G84050Medicaid
CA000G84050Medicaid