Healthcare Provider Details

I. General information

NPI: 1992721385
Provider Name (Legal Business Name): NICHOLAS JOSEPH SPEZIALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK RD SUITE 3200
ELMHURST IL
60126-5626
US

IV. Provider business mailing address

1200 S YORK RD SUITE 3200
ELMHURST IL
60126-5626
US

V. Phone/Fax

Practice location:
  • Phone: 630-758-8777
  • Fax:
Mailing address:
  • Phone: 630-758-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number036-087251
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: