Basic Information
| Provider Information | |||||||||
| NPI: | 1326013236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOBLEZA | ||||||||
| FirstName: | ALFONSO | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3603 | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605223603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737727858 | ||||||||
| FaxNumber: | 7732766668 | ||||||||
| Practice Location | |||||||||
| Address1: | 326 W 64TH ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606213114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739623900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 08/09/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036077887 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | BN1760912 | 01 | IL | DEA | OTHER | 12618087 | 01 | IL | CAQH | OTHER | F400234706 | 01 | IL | MEDICARE | OTHER | 036077887 | 05 | IL | MEDICAID | QMX000000107300 | 01 | IL | AETNA BETTER HEALTH | OTHER |