MEDICARE: CRESTWOOD MEDICAL ASSOCIATES LTD

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

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	:	1992746309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESTWOOD MEDICAL ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	13117 RIVERCREST DR
Second Line	:
City	:	CRESTWOOD
State	:	IL
Zip	:	60418-4419
Country	:	US
Telephone Number	:	708-371-1190
Fax Number	:	708-448-8812

Provider Business Practice Location Address
First Line	:	13117 RIVERCREST DR
Second Line	:
City	:	CRESTWOOD
State	:	IL
Zip	:	60418-4419
Country	:	US
Telephone Number	:	708-371-1190
Fax Number	:	708-448-8812

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTONIO NORIEGA
Credential	:	MD
Telephone Number	:	708-371-1190

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	01/09/2019

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Directions to “CRESTWOOD MEDICAL ASSOCIATES LTD ” Practice Location

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