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Individual

SCOTT R NYQUIST

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1340 CHARLES ST, SUITE 100, ROCKFORD, IL 61104
(779) 696-1900
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
(779) 696-7342

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036070249
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036070249
IL
Enumeration date
03/01/2006
Last updated
02/19/2021
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