MEDICARE: DR. NIKESH LATH M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036-138440	IL

General Provider Information

NPI Number	:	1194012260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKESH LATH M.D

Provider Business Mailing Address
First Line	:	1890 SILVER CROSS BLVD STE 410
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-9547
Country	:	US
Telephone Number	:	815-717-8730
Fax Number	:	815-717-8729

Provider Business Practice Location Address
First Line	:	1890 SILVER CROSS BLVD STE 410
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-9547
Country	:	US
Telephone Number	:	815-717-8730
Fax Number	:	815-717-8729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	11/13/2025

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