MEDICARE: NICOLE JEANETTE SPENCER 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	2084N0400X	Neurology Physician	036126475	IL

General Provider Information

NPI Number	:	1518123520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE JEANETTE SPENCER M.D.

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2040
Fax Number	:	847-570-5315

Provider Business Practice Location Address
First Line	:	5115 N FRANCISCO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3611
Country	:	US
Telephone Number	:	847-570-2570
Fax Number	:	847-933-3520

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

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	09/19/2025

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