Individual
JOSE ALFREDO NICOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
NAVAL HEALTH CLININC GREAT LAKES, BRANCH MEDICAL CLINIC 1007 USS TRANQUILITY, GREAT LAKES, IL 60088
(847) 688-2522
Mailing address
907 BUCCANEER DR APT A, GLENVIEW, IL 60026-7047
(847) 730-5246
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/20/2006
Last updated
04/18/2008
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