MEDICARE: NOEL E. LASALA 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	207Q00000X	Family Medicine Physician	036083223	IL

General Provider Information

NPI Number	:	1386646172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEL E. LASALA M.D.

Provider Business Mailing Address
First Line	:	520 E 22ND ST
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-6110
Country	:	US
Telephone Number	:	630-874-2542
Fax Number	:	630-874-2642

Provider Business Practice Location Address
First Line	:	3224 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3716
Country	:	US
Telephone Number	:	773-645-0096
Fax Number	:

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	03/22/2021

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