MEDICARE: DR. NOGA ASKENAZI MD

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	207K00000X	Allergy & Immunology Physician	036102574	IL

General Provider Information

NPI Number	:	1972518702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOGA ASKENAZI MD

Provider Business Mailing Address
First Line	:	730 E TERRA COTTA AVE
Second Line	:	STE A
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3615
Country	:	US
Telephone Number	:	847-888-8802
Fax Number	:	866-246-1164

Provider Business Practice Location Address
First Line	:	730 E TERRA COTTA AVE
Second Line	:	STE A
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3615
Country	:	US
Telephone Number	:	847-888-8802
Fax Number	:	866-246-1164

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	01/10/2017

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