Healthcare Provider Details

I. General information

NPI: 1104318872
Provider Name (Legal Business Name): NICHOLAS ROBERT PAGANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 KANEVILLE RD
GENEVA IL
60134-2578
US

IV. Provider business mailing address

2525 KANEVILLE RD
GENEVA IL
60134-2578
US

V. Phone/Fax

Practice location:
  • Phone: 630-584-1400
  • Fax: 833-464-4617
Mailing address:
  • Phone: 630-584-1400
  • Fax: 833-464-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number275244
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number036.180609
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: