Provider Demographics
NPI:1134174741
Name:NORA, MATTHEW OSCEOLA (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:OSCEOLA
Last Name:NORA
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 1:1919 S HIGHLAND AVE
Mailing Address - Street 2:SUITE B202 ATTN JAN LEWIS
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6153
Mailing Address - Country:US
Mailing Address - Phone:630-268-1102
Mailing Address - Fax:630-268-1125
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:TOWER 2 SUITE 400
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-719-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084403207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
060039321OtherRAILROAD MEDICARE
IL036084403Medicaid
IL200251004Medicare PIN
IL976790Medicare ID - Type UnspecifiedLOC 15
IL036084403Medicaid
ILK05394Medicare PIN
E56922Medicare UPIN
ILK05611Medicare ID - Type UnspecifiedLOC 99