Individual
DR. BRIAN NOVACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
29630 EUCLID AVE, WICKLIFFE, OH 44092-1829
(440) 944-6665
Mailing address
29630 EUCLID AVE, WICKLIFFE, OH 44092-1829
(440) 944-6665
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36-00-2998-N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2146270
—
OH
01
—
480031313
MEDICARE RAILROAD
OH
01
—
CH5179
MEDICARE RAILROAD
OH
01
—
DD0381
MEDICARE RAILROAD
OH
01
—
P00269217
MEDICARE RAILROAD
OH
Enumeration date
06/30/2005
Last updated
02/08/2023
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