Provider Demographics
NPI:1659371425
Name:NOVAK, JODI K (DO)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:K
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-0829
Mailing Address - Country:US
Mailing Address - Phone:480-455-3000
Mailing Address - Fax:866-819-6115
Practice Address - Street 1:16838 E PALISADES BLVD STE 153
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3786
Practice Address - Country:US
Practice Address - Phone:480-816-3131
Practice Address - Fax:844-207-3461
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3620207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ789373Medicaid
AZZ162326Medicare PIN
AZH72175Medicare UPIN
AZP00338435Medicare PIN
AZZ110716Medicare PIN
AZZ110716Medicare PIN