Provider Demographics
NPI:1972518702
Name:ASKENAZI, NOGA (MD)
Entity type:Individual
Prefix:DR
First Name:NOGA
Middle Name:
Last Name:ASKENAZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 E TERRA COTTA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3615
Mailing Address - Country:US
Mailing Address - Phone:847-888-8802
Mailing Address - Fax:866-246-1164
Practice Address - Street 1:730 E TERRA COTTA AVE
Practice Address - Street 2:STE A
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3615
Practice Address - Country:US
Practice Address - Phone:847-888-8802
Practice Address - Fax:866-246-1164
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102574207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214887Medicare PIN
ILK36124Medicare UPIN