Provider Demographics
NPI:1043345994
Name:NOVAK, MICHAEL WALTER (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WALTER
Last Name:NOVAK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1879
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96093-1879
Mailing Address - Country:US
Mailing Address - Phone:530-623-0021
Mailing Address - Fax:530-623-0025
Practice Address - Street 1:31660 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093-1879
Practice Address - Country:US
Practice Address - Phone:530-623-0021
Practice Address - Fax:530-623-0025
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17007363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical