Individual
ERNESTO NORONA FABI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
217 S LOCUST ST, PANA MEDICAL GROUP LLC, PANA, IL 62557-9998
(217) 562-2143
(217) 562-2251
Mailing address
217 S LOCUST ST, PANA, IL 62557-9998
(217) 562-2143
(217) 562-2251
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1115581
BCBS HEALTH PLAN
—
01
—
119000
3RD PARTY ADMIN HEALTH LI
—
Enumeration date
11/07/2006
Last updated
07/08/2007
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