Provider Demographics
NPI:1902197312
Name:MCKITTRICK, NOAH DAVID (MD)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:DAVID
Last Name:MCKITTRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1302 FRANKLIN AVE STE 3500
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6522
Mailing Address - Country:US
Mailing Address - Phone:309-268-6200
Mailing Address - Fax:309-268-6224
Practice Address - Street 1:1302 FRANKLIN AVE STE 3500
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6522
Practice Address - Country:US
Practice Address - Phone:309-268-6200
Practice Address - Fax:309-268-6224
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036166138207RI0200X
ORMD195130207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease