Nickoloff, Brian

Nickoloff, Brian is an individual health care provider with primary practice located at 2160 S First Ave (Ems Bldg., Rm. 2209), Maywood IL 60153. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatopathology, which is considered as his primary health care specialty. Nickoloff, Brian can be contacted via phone (708) 216-3250.

Contact Information

Primary practice address
2160 S First Ave (Ems Bldg., Rm. 2209) Maywood IL 60153
Phone: (708) 216-3250
Fax: (708) 216-2620
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatopathology 207ZD0900X 36092377 Illinois

Profile Details

NPI number 1104806272
LBN Legal business name Nickoloff, Brian
Credentials MD PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 17th, 2006
Last updated Mar 4th, 2010 - about 15 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 1104806272 NPPES
Illinois MEDICAID 36092377

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