Healthcare Provider Details

I. General information

NPI: 1932630829
Provider Name (Legal Business Name): NIKHIL MAKHIJA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3134 N CLARK ST
CHICAGO IL
60657-4414
US

IV. Provider business mailing address

4580 SOMERSET LN
BROOKFIELD WI
53045-8168
US

V. Phone/Fax

Practice location:
  • Phone: 773-766-4949
  • Fax:
Mailing address:
  • Phone: 262-844-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number102260
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS17518
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-153024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: