MEDICARE: DR. ANTONIO NORIEGA MD

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	207Q00000X	Family Medicine Physician	036049076	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21623955	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1073701850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO NORIEGA MD

Provider Business Mailing Address
First Line	:	13117 RIVERCREST DR
Second Line	:
City	:	CRESTWOOD
State	:	IL
Zip	:	60418-4419
Country	:	US
Telephone Number	:	708-371-1190
Fax Number	:	708-448-8812

Provider Business Practice Location Address
First Line	:	13117 RIVERCREST DR
Second Line	:
City	:	CRESTWOOD
State	:	IL
Zip	:	60418-4419
Country	:	US
Telephone Number	:	708-371-1190
Fax Number	:	708-448-8812

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

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	01/09/2019

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Directions to “ DR. ANTONIO NORIEGA MD” Practice Location

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