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NPI Code Detail

MEDICARE: NATHANIEL H PAE MD

MEDICARE: NATHANIEL H PAE MD
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
1207Q00000XFamily Medicine Physician036091347IL

General Provider Information

NPI Number : 1396796462
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHANIEL H PAE MD
Provider Business Mailing Address
First Line : 4201 WINFIELD RD FL 4
Second Line :
City : WARRENVILLE
State : IL
Zip : 60555-4025
Country : US
Telephone Number : 331-221-6377
Fax Number : 331-221-2357
Provider Business Practice Location Address
First Line : 172 E SCHILLER ST
Second Line :
City : ELMHURST
State : IL
Zip : 60126-2816
Country : US
Telephone Number : 331-221-9001
Fax Number : 331-221-2305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2006
Last Update Date : 05/04/2021

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