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NPI Code Detail

MEDICARE: DR. NECHOLAS GHANNAM MD

MEDICARE: DR. NECHOLAS GHANNAM 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
1207R00000XInternal Medicine Physician036112505IL
2207RG0300XGeriatric Medicine (Internal Medicine) Physician036112505IL

Other Identifiers

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

General Provider Information

NPI Number : 1962480541
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NECHOLAS GHANNAM MD
Provider Business Mailing Address
First Line : 29373 NETWORK PL
Second Line :
City : CHICAGO
State : IL
Zip : 60673-1293
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9831 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-1740
Country : US
Telephone Number : 773-445-3500
Fax Number : 773-445-1931
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 02/19/2025

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