Individual
FRED MARK NOVICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4120 WEST MAPLE ROAD, SUITE 206, BLOOMFIELD HILLS, MI 48301
(248) 932-3376
(248) 932-1046
Mailing address
7456 PADDLEWHEEL CRT, BLOOMFIELD HILLS, MI 48301
(248) 932-3376
(248) 932-1046
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
4301406190
MI
207ND0900X
Dermatopathology Physician
Primary
4301406190
MI
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
16422
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06392341
BS
—
Enumeration date
10/26/2006
Last updated
10/04/2011
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