Provider Demographics
NPI:1942287560
Name:NOISETTE, PIERRE R (MD)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:R
Last Name:NOISETTE
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 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:B-390
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2333
Mailing Address - Country:US
Mailing Address - Phone:312-567-6691
Mailing Address - Fax:312-328-7895
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:B-390
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-6691
Practice Address - Fax:312-328-7895
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081226208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081226Medicaid
IL01621679OtherBCBS OF IL
IL426580Medicare ID - Type UnspecifiedGROUP 950150
IL01621679OtherBCBS OF IL