Provider Demographics
NPI:1295213866
Name:NOVAK, KEVIN (PHD , CNIM)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:NOVAK
Suffix:
Gender:M
Credentials:PHD , CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BOX ELDER DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9234
Mailing Address - Country:US
Mailing Address - Phone:513-374-2747
Mailing Address - Fax:
Practice Address - Street 1:8118 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7350
Practice Address - Country:US
Practice Address - Phone:877-938-6537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic