Organization
CARL J NOVOTNY DO SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL J NOVOTNY DO (PHYSICIAN)
(708) 442-7780
Entity
Organization
Contact information
Practice address
8709 W CERMAK RD, NORTH RIVERSIDE, IL 60546-1128
(708) 442-7780
(708) 442-7797
Mailing address
8709 W CERMAK RD, NORTH RIVERSIDE, IL 60546-1128
(708) 442-7780
(708) 442-7797
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21621844
BLUE SHIELD
IL
Enumeration date
03/27/2007
Last updated
01/07/2008
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