Provider Demographics
NPI:1497996946
Name:NOVO, REBECCA CISSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:CISSELL
Last Name:NOVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BACHUSZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:6559 N WICKHAM RD STE C-105
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2039
Practice Address - Country:US
Practice Address - Phone:321-395-3298
Practice Address - Fax:321-241-1161
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1184442086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery