Provider Demographics
NPI:1982807467
Name:NOVIKOV, MAXIM (MD)
Entity Type:Individual
Prefix:
First Name:MAXIM
Middle Name:
Last Name:NOVIKOV
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 1:30114 WINSOR DR
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-1262
Mailing Address - Country:US
Mailing Address - Phone:440-899-9949
Mailing Address - Fax:440-899-9949
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-4801
Practice Address - Fax:216-778-5378
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57009607207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology