Carl J Novotny DO SC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

CARL J NOVOTNY DO SC

Practice address

8709 W Cermak Rd
North Riverside, IL 60546-1128

Phone

(708) 442-7780

Fax

(708) 442-7797

NPI assigned

Mar 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carl J Novotny, DO

Title

Physician

Phone

(708) 442-7780

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199664000000",
    "number": "1972621035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8709 W CERMAK RD",
            "city": "NORTH RIVERSIDE",
            "state": "IL",
            "postal_code": "605461128",
            "telephone_number": "708-442-7780",
            "fax_number": "708-442-7797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8709 W CERMAK RD",
            "city": "NORTH RIVERSIDE",
            "state": "IL",
            "postal_code": "605461128",
            "telephone_number": "708-442-7780",
            "fax_number": "708-442-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARL J NOVOTNY DO SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2008-01-07",
        "status": "A",
        "authorized_official_last_name": "NOVOTNY",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "708-442-7780",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "21621844",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrice R Blackburn, MHS, CCC-SLP
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• Vanessa Burns
• Phillip Cannizzaro, D.D.S.
• Colby Lee Carter, OD
• Alexandra Castro
• Caroline Chade
• Chicago Mall Dental Associates, LLC
• Chicago Mall Dental, LLC

• General Practice Physician in North Riverside, IL
• Providers in North Riverside, IL by specialty
• General Practice Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.