Jesse, John Nicholas

Jesse, John Nicholas is an individual health care provider with primary practice located at 836 W Wellington Ave , Chicago IL 60657-5147. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Body Imaging, Allopathic & Osteopathic Physicians / Nuclear Radiology, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Jesse, John Nicholas can be contacted via phone (773) 296-3563.

Contact Information

Primary practice address
836 W Wellington Ave Chicago IL 60657-5147
Phone: (773) 296-3563
Fax: (458) 217-7768
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Body Imaging 2085B0100X 036.157267 Illinois
Allopathic & Osteopathic Physicians / Nuclear Radiology 2085N0904X 036.157267 Illinois
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 67902-20 Wisconsin
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 036.157267 Illinois

Profile Details

NPI number 1639564115
LBN Legal business name Jesse, John Nicholas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 1st, 2015
Last updated Dec 28th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639564115 NPPES
Wisconsin MEDICAID 1639564115

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