Healthcare Provider Details

I. General information

NPI: 1912342452
Provider Name (Legal Business Name): BRIAN EDWARD NOLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 603-770-6895
  • Fax:
Mailing address:
  • Phone: 603-770-6895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number036.150256
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: