MEDICARE: NIKOLA K PUFFINBARGER 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	208600000X	Surgery Physician	18029	OK
2	2086S0120X	Pediatric Surgery Physician	036172443	IL

General Provider Information

NPI Number	:	1821066176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOLA K PUFFINBARGER MD

Provider Business Mailing Address
First Line	:	150 HARVESTER DR STE 300
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-5965
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1443
Country	:	US
Telephone Number	:	888-824-0200
Fax Number	:

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

Provider Enumeration Date	:	03/11/2006
Last Update Date	:	03/26/2025

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