Provider Demographics
NPI:1689783227
Name:NORA, ERNEST G (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:G
Last Name:NORA
Suffix:
Gender:M
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:PO BOX 95446
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60694-5446
Mailing Address - Country:US
Mailing Address - Phone:773-772-1212
Mailing Address - Fax:773-772-8666
Practice Address - Street 1:3538 WEST FULLERTON AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647
Practice Address - Country:US
Practice Address - Phone:773-772-1212
Practice Address - Fax:773-772-8666
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066176207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066176Medicaid
IL659010Medicare ID - Type Unspecified
IL036066176Medicaid