Provider Demographics
NPI:1316934029
Name:NOVOTNY, NILA M (MD)
Entity type:Individual
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First Name:NILA
Middle Name:M
Last Name:NOVOTNY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4508 38TH ST
Mailing Address - Street 2:SUITE #152
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1668
Mailing Address - Country:US
Mailing Address - Phone:402-563-4500
Mailing Address - Fax:402-563-3520
Practice Address - Street 1:4508 38TH ST
Practice Address - Street 2:SUITE #152
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1668
Practice Address - Country:US
Practice Address - Phone:402-563-4500
Practice Address - Fax:402-563-3520
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2018-02-12
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Provider Licenses
StateLicense IDTaxonomies
NE17352207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1538141593Medicaid
NE040007717OtherRAILROAD MEDICARE #
NE3891OtherMIDLANDS CHOICE PPO
NE061181648-68601-A002OtherTRIWEST
NE10025979300Medicaid
NE04465OtherBLUE CROSS OF NEBRASKA
NE06118164800Medicaid
NE061181648-68601-A002OtherTRIWEST
NE10025979300Medicaid