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NPI Code Detail

MEDICARE: NIKE BEAUBIER MD

MEDICARE: NIKE BEAUBIER 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
1207ZP0101XAnatomic Pathology Physician036130750IL
2207ZP0007XMolecular Genetic Pathology (Pathology) Physician036130750IL

General Provider Information

NPI Number : 1396994141
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKE BEAUBIER MD
Provider Business Mailing Address
First Line : 333 E ONTARIO ST
Second Line : APT# 3109B
City : CHICAGO
State : IL
Zip : 60611-4804
Country : US
Telephone Number : 917-822-6325
Fax Number :
Provider Business Practice Location Address
First Line : 251 E HURON ST
Second Line : FEINBERG 7-220
City : CHICAGO
State : IL
Zip : 60611-2908
Country : US
Telephone Number : 312-926-6692
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2008
Last Update Date : 03/04/2013

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