Provider Demographics
NPI:1942460381
Name:NOVAK FAMILY MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:NOVAK FAMILY MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-834-0132
Mailing Address - Street 1:401 E NORTH AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-1218
Mailing Address - Country:US
Mailing Address - Phone:630-834-0132
Mailing Address - Fax:630-834-0319
Practice Address - Street 1:401 E NORTH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-1218
Practice Address - Country:US
Practice Address - Phone:630-834-0132
Practice Address - Fax:630-834-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center