Healthcare Provider Details

I. General information

NPI: 1477663664
Provider Name (Legal Business Name): FRANCIS J. NICOLOSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FRANK J NICOLOSI

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N PERRYVILLE RD
ROCKFORD IL
61114-8011
US

IV. Provider business mailing address

2170 PEARL ST
BELVIDERE IL
61008-6020
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-2000
  • Fax: 815-642-8335
Mailing address:
  • Phone: 815-547-5461
  • Fax: 815-544-9681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-077918
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: