Provider Demographics
NPI:1417979360
Name:NOVA MEDICA PLLC
Entity Type:Organization
Organization Name:NOVA MEDICA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGHAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-478-1100
Mailing Address - Street 1:20331 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1411
Mailing Address - Country:US
Mailing Address - Phone:248-478-1100
Mailing Address - Fax:248-478-7054
Practice Address - Street 1:20331 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1411
Practice Address - Country:US
Practice Address - Phone:248-478-1100
Practice Address - Fax:248-478-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINT060867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4334184Medicaid
G20725Medicare UPIN
ON31880Medicare ID - Type Unspecified