Healthcare Provider Details

I. General information

NPI: 1821369265
Provider Name (Legal Business Name): NICOLE ANNE CIPRIANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE MC 6101
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

5473 S INGLESIDE AVE #1E
CHICAGO IL
60615-5038
US

V. Phone/Fax

Practice location:
  • Phone: 773-834-8375
  • Fax:
Mailing address:
  • Phone: 773-256-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036.129292
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: