MEDICARE: RUSSELL P NOCKELS 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
1	207T00000X	Neurological Surgery Physician	036100723	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750368635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL P NOCKELS MD

Provider Business Mailing Address
First Line	:	880 W CENTRAL RD STE 7200
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2382
Country	:	US
Telephone Number	:	847-618-4430
Fax Number	:	847-618-0786

Provider Business Practice Location Address
First Line	:	880 W CENTRAL RD STE 7200
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2382
Country	:	US
Telephone Number	:	847-618-4430
Fax Number	:	847-618-0786

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	10/16/2023

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Directions to “ RUSSELL P NOCKELS MD” Practice Location

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