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NPI Code Detail

MEDICARE: MISS NICHELLE J PAJEAU P.A.,

MEDICARE: MISS NICHELLE J PAJEAU P.A.,
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
1363A00000XPhysician Assistant85002728IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
185002728OTHERILPROFESSIONAL LICENCE

General Provider Information

NPI Number : 1609950807
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS NICHELLE J PAJEAU P.A.,
Provider Business Mailing Address
First Line : 6131 DEMPSTER ST
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-2953
Country : US
Telephone Number : 847-967-5010
Fax Number : 847-967-5147
Provider Business Practice Location Address
First Line : 6131 DEMPSTER ST
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-2953
Country : US
Telephone Number : 847-967-5010
Fax Number : 847-967-5147
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 12/14/2021

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