Provider Demographics
NPI:1053339499
Name:NORA, MARYANNETTE E (MD)
Entity type:Individual
Prefix:MRS
First Name:MARYANNETTE
Middle Name:E
Last Name:NORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6969 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2527
Mailing Address - Country:US
Mailing Address - Phone:847-674-1200
Mailing Address - Fax:847-674-1332
Practice Address - Street 1:6969 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2527
Practice Address - Country:US
Practice Address - Phone:847-674-1200
Practice Address - Fax:847-674-1332
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081784Medicaid
IL110040056OtherMEDICARE RAILROAD
ILCF5018OtherMEDICARE RAILROAD
IL948660Medicare PIN
ILE86435Medicare UPIN