Basic Information
| Provider Information | |||||||||
| NPI: | 1538163456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOORLAG | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 WINFIELD RD FL 4 | ||||||||
| Address2: | |||||||||
| City: | WARRENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605554025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312216377 | ||||||||
| FaxNumber: | 3312212357 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 S MAIN ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601482670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312219004 | ||||||||
| FaxNumber: | 3312212760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 06/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 016003832 | IL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213E00000X | 016.003832 | IL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 02230069 | 01 | IL | BLUE CROSS/BLUE SHIELD | OTHER | 0004932042 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 480008434 | 01 | IL | RAILROAD MEDICARE | OTHER |