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General NPI Number Information
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NPI Number | 1275761488
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Entity Type | Individual
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Provider Name | NICHOLE SUZANNE LUPEI D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 2511 N KEDZIE BLVD
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City | CHICAGO
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State | IL
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Zip | 60647-2603
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Country | US
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Telephone | 773-292-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 701 LEE ST SUITE 300
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City | DES PLAINES
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State | IL
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Zip | 60016-4539
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Country | US
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Telephone | 847-390-5900
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125-056508
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License Number State | IL
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