Provider Demographics
NPI:1538476593
Name:HERRERA NOVEY, WALDO (MD, MSC, FACP)
Entity Type:Individual
Prefix:
First Name:WALDO
Middle Name:
Last Name:HERRERA NOVEY
Suffix:
Gender:M
Credentials:MD, MSC, FACP
Other - Prefix:DR
Other - First Name:WALDO
Other - Middle Name:
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MSC, FACP
Mailing Address - Street 1:9600 GROSS POINT RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1214
Mailing Address - Country:US
Mailing Address - Phone:847-933-6410
Mailing Address - Fax:847-933-6411
Practice Address - Street 1:9600 GROSS POINT RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-933-6410
Practice Address - Fax:847-933-6411
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130683207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine