Provider Demographics
NPI:1740674464
Name:NOVO PLASTIC SURGERY LLC
Entity type:Organization
Organization Name:NOVO PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:KIT
Authorized Official - Last Name:SHADDIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-316-1515
Mailing Address - Street 1:5147 N 9TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8771
Mailing Address - Country:US
Mailing Address - Phone:904-316-1515
Mailing Address - Fax:
Practice Address - Street 1:5147 N 9TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8771
Practice Address - Country:US
Practice Address - Phone:904-316-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME995962086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty