MEDICARE: JONATHAN P. NOLAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	036074725	IL

General Provider Information

NPI Number	:	1225013246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN P. NOLAN M.D.

Provider Business Mailing Address
First Line	:	1860 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 S CLAY ST # LL10
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-3257
Country	:	US
Telephone Number	:	630-432-6848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	04/23/2021

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