Provider Demographics
NPI:1366630709
Name:NOVAC, STEFAN (MD)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:NOVAC
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 1:601 N FLAMINGO RD STE 406
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1012
Mailing Address - Country:US
Mailing Address - Phone:754-201-3700
Mailing Address - Fax:754-201-3711
Practice Address - Street 1:601 N FLAMINGO RD STE 406
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1012
Practice Address - Country:US
Practice Address - Phone:754-201-3700
Practice Address - Fax:754-201-3711
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2019-09-04
Deactivation Date:2018-12-01
Deactivation Code:
Reactivation Date:2018-12-11
Provider Licenses
StateLicense IDTaxonomies
FLME113453207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102671800Medicaid