Provider Demographics
NPI:1770511743
Name:NOVAK, CHARLES CHRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHRIS
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 ALLUMBAUGH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9212
Mailing Address - Country:US
Mailing Address - Phone:208-323-1125
Mailing Address - Fax:208-323-9604
Practice Address - Street 1:413 ALLUMBAUGH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9212
Practice Address - Country:US
Practice Address - Phone:208-323-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM49222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B63775Medicare UPIN
ID1118122Medicare PIN