Provider Demographics
NPI:1740367895
Name:NOVAK, WILLIAM V (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:V
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5405 NORTH KNOXVILLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:309-691-4410
Mailing Address - Fax:309-589-2830
Practice Address - Street 1:1505 EASTLAND DR.
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701
Practice Address - Country:US
Practice Address - Phone:309-691-4410
Practice Address - Fax:309-589-2830
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-093560207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-093560Medicaid
ILK32775Medicare ID - Type Unspecified
ILF01321Medicare UPIN