Provider Demographics
NPI:1174623862
Name:DEBACKER, NOEL ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:ALBERT
Last Name:DEBACKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-503-6000
Mailing Address - Fax:312-503-6329
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 118
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-503-6000
Practice Address - Fax:312-503-6329
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45630Medicare UPIN
IL688120Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER