Provider Demographics
NPI:1043617137
Name:NOVAS, CATHERINE WOLPERT (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:WOLPERT
Last Name:NOVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 S GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3056
Mailing Address - Country:US
Mailing Address - Phone:847-235-2510
Mailing Address - Fax:
Practice Address - Street 1:280 S GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-3056
Practice Address - Country:US
Practice Address - Phone:847-235-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361014882080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities