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NPI Code Detail

MEDICARE: NICOLE M. GLADCHENKO PA-C

MEDICARE: NICOLE M. GLADCHENKO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant3101-23WI
2363A00000XPhysician Assistant085.007852IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11437492675OTHERWIBCBSWI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42630OTHERWIMERCYCARE INSURANCE
5K400452296OTHERWIWI MEDICICARE

General Provider Information

NPI Number : 1437492675
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE M. GLADCHENKO PA-C
Provider Business Mailing Address
First Line : PO BOX 734240
Second Line :
City : CHICAGO
State : IL
Zip : 60673-4240
Country : US
Telephone Number : 815-744-8554
Fax Number : 630-495-1770
Provider Business Practice Location Address
First Line : 2500 W HIGGINS RD STE 1040
Second Line :
City : HOFFMAN ESTATES
State : IL
Zip : 60169-2049
Country : US
Telephone Number : 847-884-8096
Fax Number : 847-490-0978
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2013
Last Update Date : 11/14/2022

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