Provider Demographics
NPI:1629295647
Name:NORA MEDICAL GROUP, S.C.
Entity Type:Organization
Organization Name:NORA MEDICAL GROUP, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-674-1200
Mailing Address - Street 1:6969 NORTH LINCOLN AVENUE
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 NORTH LINCOLN AVENUE
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042000021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615916OtherBCBS GROUP NUMBER
IL01615916OtherBCBS GROUP NUMBER