Healthcare Provider Details

I. General information

NPI: 1841282126
Provider Name (Legal Business Name): NICHOLAS A. LYGIZOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 DEMPSTER ST STE 501
PARK RIDGE IL
60068-8429
US

IV. Provider business mailing address

2604 DEMPSTER ST STE 501
PARK RIDGE IL
60068-8429
US

V. Phone/Fax

Practice location:
  • Phone: 847-674-5585
  • Fax:
Mailing address:
  • Phone: 847-674-5585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036-066646
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: