Healthcare Provider Details

I. General information

NPI: 1669835393
Provider Name (Legal Business Name): NOAH COOPER LANDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE. IM HOSPITALISTS STE 4210
EVANSTON IL
60201
US

IV. Provider business mailing address

2650 RIDGE AVE. IM HOSPITALISTS STE 4210
EVANSTON IL
60201
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1010
  • Fax: 847-733-5108
Mailing address:
  • Phone: 847-570-1010
  • Fax: 847-733-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036151056
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036151056
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: