Healthcare Provider Details

I. General information

NPI: 1083816201
Provider Name (Legal Business Name): NICHOLAS ROBERT KUNIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 FLETCHER DR
ELGIN IL
60123-4747
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-6600
  • Fax: 847-695-4279
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-134798
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: