Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 036084403 | IL |
NPI | 1134174741 |
---|---|
Provider Name | Matthew Osceola Nora |
First Address | Lombard, IL 60148-6153 |
Second Address | Downers Grove, IL 60515-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 23/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036084403 | (05) | IL |
060039321 | RAILROAD MEDICARE (01) | |
E56922 | (02) |