Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 036-113827 | IL |
NPI | 1124014386 |
---|---|
Provider Name | Dimitrios Nikas |
First Address | Chicago, IL 60614-5816 |
Second Address | Chicago, IL 60614-5816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-113827 | (05) | IL |