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NPI Code Detail

MEDICARE: MR. DAVID M NOBLE LAT, ATC

MEDICARE: MR. DAVID M NOBLE LAT, ATC
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
12255A2300XAthletic Trainer36000521AIN
22255A2300XAthletic TrainerIL

General Provider Information

NPI Number : 1386619989
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID M NOBLE LAT, ATC
Provider Business Mailing Address
First Line : 7607 BANCASTER DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-5717
Country : US
Telephone Number : 317-876-3216
Fax Number :
Provider Business Practice Location Address
First Line : 9645 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-1722
Country : US
Telephone Number : 773-239-2734
Fax Number : 773-239-2784
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 12/10/2007

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