Provider Demographics
NPI:1962478271
Name:STADLAN, NOAM Y (MD)
Entity Type:Individual
Prefix:
First Name:NOAM
Middle Name:Y
Last Name:STADLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9650 GROSS POINT RD STE 2900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-5006
Mailing Address - Country:US
Mailing Address - Phone:847-570-1440
Mailing Address - Fax:847-570-1442
Practice Address - Street 1:9650 GROSS POINT RD STE 2900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-5006
Practice Address - Country:US
Practice Address - Phone:847-570-1440
Practice Address - Fax:847-570-1442
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036091078207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360910781Medicaid
IL0360910781Medicaid
ILK37647Medicare PIN
G14719Medicare UPIN