Basic Information
| Provider Information | |||||||||
| NPI: | 1689744351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVAK | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | EDMUND | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2799 W GRAND BLVD, CFP-505 | ||||||||
| Address2: | DIVISION OF NEPHROLOGY, HENRY FORD HEALTH SYSTEM | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139162710 | ||||||||
| FaxNumber: | 3139162554 | ||||||||
| Practice Location | |||||||||
| Address1: | 2799 W GRAND BLVD, CFP-505 | ||||||||
| Address2: | DIVISION OF NEPHROLOGY, HENRY FORD HEALTH SYSTEM | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139162710 | ||||||||
| FaxNumber: | 3139162554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 4301080011 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | 4301080011 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.