Provider Demographics
NPI:1972516680
Name:NOVAK, STEPHEN BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRUCE
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 1:1150 N 35TH AVE
Mailing Address - Street 2:#590
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-963-7191
Mailing Address - Fax:954-894-3320
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:#590
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-963-7191
Practice Address - Fax:954-894-3320
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0021354207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
78121OtherBLUE CROSS
78121OtherBLUE CROSS
FL78121BMedicare ID - Type Unspecified