Provider Demographics
NPI:1194876029
Name:NOVAK, GARY JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAMES
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1329 ROYAL OAK LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3160
Mailing Address - Country:US
Mailing Address - Phone:847-644-2346
Mailing Address - Fax:847-998-1042
Practice Address - Street 1:2221 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1435
Practice Address - Country:US
Practice Address - Phone:847-251-3770
Practice Address - Fax:847-251-3771
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2015-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-058228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031600515OtherBCBS
IL0031600515OtherBCBS
ILC41189Medicare UPIN