Provider Demographics
NPI:1851460737
Name:FABI, ERNESTO NORONA (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:NORONA
Last Name:FABI
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 1:217 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-9998
Mailing Address - Country:US
Mailing Address - Phone:217-562-2143
Mailing Address - Fax:217-562-2251
Practice Address - Street 1:217 S LOCUST ST
Practice Address - Street 2:PANA MEDICAL GROUP LLC
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-9998
Practice Address - Country:US
Practice Address - Phone:217-562-2143
Practice Address - Fax:217-562-2251
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
119000Other3RD PARTY ADMIN HEALTH LI
1115581OtherBCBS HEALTH PLAN
1115581OtherBCBS HEALTH PLAN
C37333Medicare UPIN