Provider Demographics
NPI:1093888182
Name:MICHAEL NOVAK, M.D., INC
Entity Type:Organization
Organization Name:MICHAEL NOVAK, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-244-7281
Mailing Address - Street 1:633 N CENTRAL AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1801
Mailing Address - Country:US
Mailing Address - Phone:818-244-7281
Mailing Address - Fax:818-244-5912
Practice Address - Street 1:633 N CENTRAL AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1801
Practice Address - Country:US
Practice Address - Phone:818-244-7281
Practice Address - Fax:818-244-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G84050Medicaid
CAW3952Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID