Provider Demographics
NPI:1679604482
Name:NOVIA, MICHAEL V (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:V
Last Name:NOVIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3920 CAPITAL MALL DRIVE SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8702
Mailing Address - Country:US
Mailing Address - Phone:360-943-0755
Mailing Address - Fax:360-754-7885
Practice Address - Street 1:3920 CAPITAL MALL DRIVE SW
Practice Address - Street 2:SUITE 201
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8702
Practice Address - Country:US
Practice Address - Phone:360-943-0755
Practice Address - Fax:360-754-7885
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-10-17
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Provider Licenses
StateLicense IDTaxonomies
WAMD00039718208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8866466Medicare PIN