Healthcare Provider Details

I. General information

NPI: 1730144171
Provider Name (Legal Business Name): NICHOLAS J TAPAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 FOXFIELD RD #203
ST CHARLES IL
60174-5799
US

IV. Provider business mailing address

2900 FOXFIELD RD #203
ST CHARLES IL
60174-5799
US

V. Phone/Fax

Practice location:
  • Phone: 630-797-4255
  • Fax: 630-797-4259
Mailing address:
  • Phone: 630-797-4255
  • Fax: 630-797-4259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036093506
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: