Healthcare Provider Details

I. General information

NPI: 1427410885
Provider Name (Legal Business Name): NOGA JENNY GAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 S MICHIGAN AVE
CHICAGO IL
60605-2810
US

IV. Provider business mailing address

1471 S MICHIGAN AVE
CHICAGO IL
60605-2810
US

V. Phone/Fax

Practice location:
  • Phone: 123-202-0300
  • Fax: 312-202-0383
Mailing address:
  • Phone: 312-202-0300
  • Fax: 123-202-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1427410885
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: