MEDICARE: NORA MEDICAL GROUP, S.C.

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	207R00000X	Internal Medicine Physician	042000021	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01615916	OTHER	IL	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1629295647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORA MEDICAL GROUP, S.C.

Provider Business Mailing Address
First Line	:	6969 NORTH LINCOLN AVENUE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2527
Country	:	US
Telephone Number	:	847-674-1200
Fax Number	:	847-674-1332

Provider Business Practice Location Address
First Line	:	6969 NORTH LINCOLN AVENUE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2527
Country	:	US
Telephone Number	:	847-674-1200
Fax Number	:	847-674-1332

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARYANNETTE NORA
Credential	:	M.D.
Telephone Number	:	847-674-1200

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	11/13/2008

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