Individual
DR. KIERAN JOSEPH NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7803 DREW AVE, BURR RIDGE, IL 60527-6946
(630) 650-8392
(630) 317-3310
Mailing address
7803 DREW AVE, BURR RIDGE, IL 60527-6946
(630) 650-8392
(630) 317-3310
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036-076743
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036076743
BC/BS
IL
05
—
036076743
—
IL
01
—
110216107
RAILROAD MEDICARE ID
IL
Enumeration date
08/01/2006
Last updated
11/29/2010
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