Individual
NOVIE SROA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2601 COOLIDGE RD STE 200, EAST LANSING, MI 48823-6381
(517) 203-3000
(517) 203-3003
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
EMC0005108
MI
207N00000X
Dermatology Physician
S0228
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
402673401
—
TX
01
—
8LQ705
BCBS
TX
Enumeration date
04/04/2007
Last updated
02/24/2026
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