Provider Demographics
NPI:1972560795
Name:STILL, NOAH L (MD)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:L
Last Name:STILL
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 1:2905 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4274
Mailing Address - Country:US
Mailing Address - Phone:217-877-9117
Mailing Address - Fax:217-877-3077
Practice Address - Street 1:2905 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4274
Practice Address - Country:US
Practice Address - Phone:217-877-9117
Practice Address - Fax:217-877-3077
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.043020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043020Medicaid
IL036043020Medicaid
ILK05598Medicare ID - Type Unspecified