Provider Demographics
NPI:1689687790
Name:NOOTENS, RAYMOND H (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:H
Last Name:NOOTENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4401 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:STICKNEY
Mailing Address - State:IL
Mailing Address - Zip Code:60402-4250
Mailing Address - Country:US
Mailing Address - Phone:708-788-3400
Mailing Address - Fax:708-788-3472
Practice Address - Street 1:4401 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:STICKNEY
Practice Address - State:IL
Practice Address - Zip Code:60402-4250
Practice Address - Country:US
Practice Address - Phone:708-788-3400
Practice Address - Fax:708-788-3472
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036044697207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044697Medicaid
ILC38527Medicare UPIN
IL036044697Medicaid