Healthcare Provider Details

I. General information

NPI: 1891306577
Provider Name (Legal Business Name): NARDEEN MORKOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S FAIRFIELD AVE
CHICAGO IL
60608-1782
US

IV. Provider business mailing address

4 ELM CREEK DR APT 515
ELMHURST IL
60126-5291
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-6097
  • Fax:
Mailing address:
  • Phone: 980-319-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.075428
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: