Healthcare Provider Details

I. General information

NPI: 1265359707
Provider Name (Legal Business Name): NICU CHEPTENE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 SARATOGA AVE APT 217
DOWNERS GROVE IL
60515-1957
US

IV. Provider business mailing address

4250 SARATOGA AVE APT 217
DOWNERS GROVE IL
60515-1957
US

V. Phone/Fax

Practice location:
  • Phone: 773-557-5644
  • Fax:
Mailing address:
  • Phone: 773-557-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: