Provider Demographics
NPI:1235160433
Name:NOVAS, JEANNE B (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:B
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 1:111 LIONS DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3182
Mailing Address - Country:US
Mailing Address - Phone:847-304-0044
Mailing Address - Fax:847-304-5885
Practice Address - Street 1:111 LIONS DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3182
Practice Address - Country:US
Practice Address - Phone:847-304-0044
Practice Address - Fax:847-304-5885
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073986174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360739864Medicaid
IL0360739864Medicaid
E63909Medicare UPIN