Provider Demographics
NPI:1679586929
Name:KENNETH A NOFFSINGER MD LTD
Entity Type:Organization
Organization Name:KENNETH A NOFFSINGER MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-377-0106
Mailing Address - Street 1:2320 DEAN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1068
Mailing Address - Country:US
Mailing Address - Phone:630-377-0106
Mailing Address - Fax:630-377-1186
Practice Address - Street 1:960 N 5TH AVE STE E
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1205
Practice Address - Country:US
Practice Address - Phone:630-584-8877
Practice Address - Fax:630-584-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209272Medicare ID - Type Unspecified