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General NPI Number Information
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NPI Number | 1265639652
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Entity Type | Individual
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Provider Name | NICOLE FANYA SIPARSKY M.D., F.A.C.S.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 1653 W CONGRESS PKWY # 785
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City | CHICAGO
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State | IL
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Zip | 60612-3833
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Country | US
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Telephone | 312-942-6379
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Fax |
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Provider Business Mailing Address
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Address Line | 1653 W CONGRESS PKWY # 785
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City | CHICAGO
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State | IL
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Zip | 60612-3833
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Country | US
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Telephone | 312-942-6379
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036135778
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 036-135778
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 036-135778
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License Number State | IL
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