1538476593 NPI number — WALDO HERRERA NOVEY MD, MSC, FACP

Table of content: WALDO HERRERA NOVEY MD, MSC, FACP (NPI 1538476593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538476593 NPI number — WALDO HERRERA NOVEY MD, MSC, FACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRERA NOVEY
Provider First Name:
WALDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MSC, FACP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERRERA
Provider Other First Name:
WALDO
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, MSC, FACP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538476593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9600 GROSS POINT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60076-1214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-933-6410
Provider Business Mailing Address Fax Number:
847-933-6411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9600 GROSS POINT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-933-6410
Provider Business Practice Location Address Fax Number:
847-933-6411
Provider Enumeration Date:
09/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036130683 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 036130683 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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