Healthcare Provider Details

I. General information

NPI: 1740448927
Provider Name (Legal Business Name): NICOLE PAPASTATHIS HUFFMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE PAPASTATHIS M.D.

II. Dates (important events)

Enumeration Date: 05/24/2008
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SKOKIE BLVD SUITE 475
NORTHBROOK IL
60062-2816
US

IV. Provider business mailing address

400 SKOKIE BLVD SUITE 475
NORTHBROOK IL
60062-2816
US

V. Phone/Fax

Practice location:
  • Phone: 847-272-4433
  • Fax: 847-272-4434
Mailing address:
  • Phone: 847-272-4433
  • Fax: 847-272-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036.130234
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: