Provider Demographics
NPI:1073763181
Name:NOVOSAD, LAURIE SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:SUSAN
Last Name:NOVOSAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:SUSAN
Other - Last Name:NORCROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11551 FOREST CENTRAL DR STE 133
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3915
Mailing Address - Country:US
Mailing Address - Phone:214-343-8565
Mailing Address - Fax:
Practice Address - Street 1:5236 W UNIVERSITY DR STE 4300
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-8128
Practice Address - Country:US
Practice Address - Phone:214-884-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2746208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX326520903Medicaid
TXTXB160819Medicare UPIN