Provider Demographics
NPI:1295802494
Name:NEQUIN, NOEL D (MD)
Entity type:Individual
Prefix:MR
First Name:NOEL
Middle Name:D
Last Name:NEQUIN
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 1:2103 S 60TH CT
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2042
Mailing Address - Country:US
Mailing Address - Phone:708-933-3840
Mailing Address - Fax:708-933-3841
Practice Address - Street 1:2103 S 60TH CT
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2042
Practice Address - Country:US
Practice Address - Phone:708-933-3840
Practice Address - Fax:708-933-3841
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360042099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1615474OtherBCBS
IL366497872Medicaid
1615474OtherBLUE SHIELD
1615474OtherBLUE SHIELD
1615474OtherBCBS
452890Medicare ID - Type Unspecified