MEDICARE: ELISABETH NOELKE MD PA

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	J0164	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	8F22613	OTHER	TX	MEDICARE PTAN RENDERING NPI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0025SJ	OTHER	BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205066289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELISABETH NOELKE MD PA

Provider Business Mailing Address
First Line	:	12 E TWOHIG AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76903-6433
Country	:	US
Telephone Number	:	325-617-9065
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 E TWOHIG AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76903-6433
Country	:	US
Telephone Number	:	325-617-9065
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	ELISABETH NOELKE
Credential	:	M.D.
Telephone Number	:	325-617-9065

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	10/30/2014

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Directions to “ELISABETH NOELKE MD PA ” Practice Location

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