Provider Demographics
NPI:1750350765
Name:NOVO, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:NOVO
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 1:7480 FAIRWAY DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6879
Mailing Address - Country:US
Mailing Address - Phone:305-558-1598
Mailing Address - Fax:305-558-6016
Practice Address - Street 1:7480 FAIRWAY DR
Practice Address - Street 2:SUITE 208
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6879
Practice Address - Country:US
Practice Address - Phone:305-558-1598
Practice Address - Fax:305-558-6016
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063955900Medicaid
FL212121OtherSTAYWELL HEALTH PLAN
FL015485OtherAETNA
FL11853OtherBLURE CROSS BLUE SHIELD
FL19469OtherWELLCARE
FL006233OtherNEIGHBORHOOD HEALTH PLAN
FL207893OtherAMERIGROUP
FL063955900Medicaid