MEDICARE: DR. CARLOS ERNESTO NOLASCO MORALES M.D.

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	207RH0005X	Hypertension Specialist Physician	036138431	IL
2	207R00000X	Internal Medicine Physician	036-138431	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	F400698494	OTHER	IL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235484866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS ERNESTO NOLASCO MORALES M.D.

Provider Business Mailing Address
First Line	:	2317 S BATES AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4337
Country	:	US
Telephone Number	:	866-477-7472
Fax Number	:	217-717-2268

Provider Business Practice Location Address
First Line	:	2317 S BATES AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4337
Country	:	US
Telephone Number	:	866-477-7472
Fax Number	:	217-717-2268

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

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	12/02/2020

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