Provider Demographics
NPI:1992795496
Name:NOVAK, PAUL HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HENRY
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6079 NE 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-1531
Mailing Address - Country:US
Mailing Address - Phone:515-289-1981
Mailing Address - Fax:515-289-4051
Practice Address - Street 1:6079 NE 9TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-1531
Practice Address - Country:US
Practice Address - Phone:515-289-1981
Practice Address - Fax:515-289-4051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26380207P00000X
NE17333207P00000X
KY24972207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA281212Medicare ID - Type Unspecified
IAA03555Medicare UPIN
IA278531Medicare ID - Type Unspecified