Provider Demographics
NPI:1609997949
Name:DR. JOSEPH NOVOSEL
Entity Type:Organization
Organization Name:DR. JOSEPH NOVOSEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVOSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:409-899-1340
Mailing Address - Street 1:2850 EASTEX FWY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77703-4618
Mailing Address - Country:US
Mailing Address - Phone:409-899-1340
Mailing Address - Fax:409-899-5184
Practice Address - Street 1:608 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5530
Practice Address - Country:US
Practice Address - Phone:337-474-6181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0564213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1669458Medicaid
TX00AM11Medicare ID - Type Unspecified
LA1669458Medicaid
TXT15074Medicare UPIN