Organization
CHICAGO SOUTH ORTHOPEDICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK R NIKKEL D.O. (ORTHOPEDIC SURGEN)
(708) 423-8440
Entity
Organization
Contact information
Practice address
5540 W 111TH ST, OAK LAWN, IL 60453-5574
(708) 423-8440
(708) 658-2958
Mailing address
5540 W 111TH ST, OAK LAWN, IL 60453-5574
(708) 423-8440
(708) 658-2958
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SSN
IL
01
—
1699762336
NPI # INDIV.
IL
01
—
31622992
BCBS
IL
Enumeration date
03/29/2007
Last updated
05/21/2020
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