Healthcare Provider Details

I. General information

NPI: 1174552228
Provider Name (Legal Business Name): DAVID H NAOUR MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 FRANKLIN AVE STE 210
NORMAL IL
61761-3588
US

IV. Provider business mailing address

1300 FRANKLIN AVE STE 210
NORMAL IL
61761-3588
US

V. Phone/Fax

Practice location:
  • Phone: 309-268-3900
  • Fax: 309-268-3910
Mailing address:
  • Phone: 309-268-3900
  • Fax: 309-268-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036095383
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: