Provider Demographics
NPI:1376650861
Name:NOVOSEL, NICKOLA (MD)
Entity Type:Individual
Prefix:
First Name:NICKOLA
Middle Name:
Last Name:NOVOSEL
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 1:12255 S 80TH AVENUE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-923-7900
Mailing Address - Fax:708-923-7915
Practice Address - Street 1:12255 S 80TH AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-923-7900
Practice Address - Fax:708-923-7915
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36047506207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C42056Medicare UPIN