Individual
TIMOTHY GEORGE NOVICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
257 W SAINT GEORGE AVE, GRANTSBURG, WI 54840-7827
(715) 463-5353
(715) 463-2753
Mailing address
257 W SAINT GEORGE AVE, GRANTSBURG, WI 54840-7827
(715) 463-5317
(715) 463-2753
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41604
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32597700
—
WI
05
—
923275300
—
MN
Enumeration date
12/05/2006
Last updated
12/14/2012
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