Provider Demographics
NPI:1114032141
Name:NOVAK, LOUIS J (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:J
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9485 MENTOR AVE STE 3
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8711
Practice Address - Country:US
Practice Address - Phone:440-205-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0324912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000529632OtherANTHEM
OH000000140692OtherANTHEM
OH000000224314OtherUNISON
OH0312370Medicaid
OH363884OtherWELLCARE
OH920004651OtherRAILROAD MEDICARE
OH739357OtherBUCKEYE
OH2119518OtherAETNA
OHP00962526Medicare PIN
OH000000529632OtherANTHEM
OHNO0638703Medicare PIN
OH000000224314OtherUNISON
OH363884OtherWELLCARE