Provider Demographics
NPI:1568509040
Name:NOVAK, ROBERT ALLEN (MS, CO)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALLEN
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MS, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 ELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-2034
Mailing Address - Country:US
Mailing Address - Phone:708-246-8383
Mailing Address - Fax:
Practice Address - Street 1:7025 VETERANS BLVD STE B
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5695
Practice Address - Country:US
Practice Address - Phone:877-320-6588
Practice Address - Fax:877-206-0235
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213-000228222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist