Healthcare Provider Details

I. General information

NPI: 1568725521
Provider Name (Legal Business Name): NICOLE KRISTIN ALEXANDER-ANYAOGU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 02/06/2022
Certification Date: 02/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1010
US

IV. Provider business mailing address

20201 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1010
US

V. Phone/Fax

Practice location:
  • Phone: 708-756-1000
  • Fax:
Mailing address:
  • Phone: 708-756-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036143240
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: