Provider Demographics
NPI:1336194711
Name:NOBLE, COURTNEY ANDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ANDERSON
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ANDERSON
Other - Last Name:APPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:259 E ERIE ST
Mailing Address - Street 2:STE 2230
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2987
Mailing Address - Country:US
Mailing Address - Phone:312-926-6000
Mailing Address - Fax:312-926-8267
Practice Address - Street 1:259 E ERIE ST
Practice Address - Street 2:STE 2230
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2987
Practice Address - Country:US
Practice Address - Phone:312-926-6000
Practice Address - Fax:312-926-8267
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111368Medicaid
ILK28396Medicare PIN
I18957Medicare UPIN