Provider Demographics
NPI:1518352962
Name:BENNETT, NOEL MIRIAM (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:MIRIAM
Last Name:BENNETT
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 1:240 EAST HURON STREET, SUITE 1-200
Mailing Address - Street 2:MCGAW MEDICAL CENTER OF NORTHWESTERN
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-695-1259
Mailing Address - Fax:
Practice Address - Street 1:240 EAST HURON STREET, SUITE 1-200
Practice Address - Street 2:MCGAW MEDICAL CENTER OF NORTHWESTERN
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-695-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125066937207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program