Provider Demographics
NPI:1316982481
Name:PETAR N NOVAKOVIC MD PC
Entity type:Organization
Organization Name:PETAR N NOVAKOVIC MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETAR
Authorized Official - Middle Name:N
Authorized Official - Last Name:NOVAKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-775-9333
Mailing Address - Street 1:604 W WARNER RD
Mailing Address - Street 2:SUITE E101
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2906
Mailing Address - Country:US
Mailing Address - Phone:480-775-4700
Mailing Address - Fax:480-775-4780
Practice Address - Street 1:604 W WARNER RD
Practice Address - Street 2:SUITE E101
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2906
Practice Address - Country:US
Practice Address - Phone:480-775-4700
Practice Address - Fax:480-775-4780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty