Provider Demographics
NPI:1316053093
Name:NOVAK, IRWIN S (MD)
Entity type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:S
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 HERMANN DR
Mailing Address - Street 2:SUITE 745
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7018
Mailing Address - Country:US
Mailing Address - Phone:713-630-0228
Mailing Address - Fax:
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:SUITE 745
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-630-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2761174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115445201Medicaid
TX115445201Medicaid
TX00LA63Medicare PIN