Provider Demographics
NPI:1497765093
Name:NENABER, MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:NENABER
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 1:2801 MATHERS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7064
Mailing Address - Country:US
Mailing Address - Phone:217-789-3600
Mailing Address - Fax:217-726-5867
Practice Address - Street 1:2801 MATHERS RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7064
Practice Address - Country:US
Practice Address - Phone:217-789-3600
Practice Address - Fax:217-726-5867
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL170769OtherPERSONAL CARE
ILCD7143OtherRR MEDICARE GROUP
IL036054063Medicaid
IL6394POtherCATERPILLAR
IL060936OtherHEALTH ALLIANCE
IL371363944OtherIRS TAX ID
IL020057300OtherBLACK LUNG
IL101559OtherHEALTHLINK
IL133586700OtherACS-OWCP
IL14D0949277OtherCLIA
IL08421024OtherBC/BS
IL110201128OtherRR MEDICARE PIN
IL036054063OtherIL STATE LICENSE
ILK09120Medicare PIN
IL233260Medicare ID - Type UnspecifiedIL MEDICARE LOC 99 GROUP#
IL020057300OtherBLACK LUNG
IL371363944OtherIRS TAX ID
IL170769OtherPERSONAL CARE