Provider Demographics
NPI:1669404620
Name:NOONAN, DANIEL JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:NOONAN
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 1:520 S MAPLE AVE
Mailing Address - Street 2:RUSH OAK PARK HOSPITAL EMERGENCY ROOM
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1022
Mailing Address - Country:US
Mailing Address - Phone:708-660-6000
Mailing Address - Fax:708-660-2374
Practice Address - Street 1:520 S MAPLE AVE
Practice Address - Street 2:RUSH OAK PARK HOSPITAL EMERGENCY ROOM
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1022
Practice Address - Country:US
Practice Address - Phone:708-660-6000
Practice Address - Fax:708-660-2374
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062839207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL31952Medicaid
ILL31952Medicaid
IL11951Medicare ID - Type UnspecifiedPHYSCIANS' GROUP NUMBER