Provider Demographics
NPI:1235484866
Name:NOLASCO MORALES, CARLOS ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ERNESTO
Last Name:NOLASCO MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 S BATES AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4337
Mailing Address - Country:US
Mailing Address - Phone:866-477-7472
Mailing Address - Fax:217-717-2268
Practice Address - Street 1:2317 S BATES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4337
Practice Address - Country:US
Practice Address - Phone:866-477-7472
Practice Address - Fax:217-717-2268
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036138431207RH0005X
IL036-138431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036138431Medicaid
ILF400698494OtherMEDICARE PTAN