MEDICARE: DR. STEPHEN F NORONHA 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	2084P0800X	Psychiatry Physician		IL

General Provider Information

NPI Number	:	1649388273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN F NORONHA M.D

Provider Business Mailing Address
First Line	:	658 S CEDAR AVE
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-4609
Country	:	US
Telephone Number	:	312-569-7135
Fax Number	:	312-569-6144

Provider Business Practice Location Address
First Line	:	900 S DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3730
Country	:	US
Telephone Number	:	312-569-7135
Fax Number	:	312-569-6144

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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