Individual
RUSSELL A NOVAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 THEDA CLARK MEDICAL PLAZA, SUITE 480, NEENAH, WI 54956
(920) 729-0608
(920) 729-2902
Mailing address
200 THEDA CLARK MEDICAL PLAZA, SUITE 480, NEENAH, WI 54956
(920) 729-0608
(920) 729-2902
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
48910
WI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
48910
WI
207RP1001X
Pulmonary Disease Physician
197207
NY
207RP1001X
Pulmonary Disease Physician
Primary
48910
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34826700
—
WI
Enumeration date
11/02/2005
Last updated
01/30/2018
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