Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036135778 | IL |
N | 208600000X | Surgeon | 036135778 | IL |
Y | 2086S0102X | Surgical Critical Care | 036-135778 | IL |
N | 2086S0127X | Trauma Surgeon | 036-135778 | IL |
NPI | 1265639652 |
---|---|
Provider Name | Dr. Nicole Fanya Siparsky |
First Address | Chicago, IL 60612-3833 |
Second Address | Chicago, IL 60612-3833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 08/12/2020 |