Individual
DR. THOMAS J NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1611 W HARRISON ST, SUITE 550, CHICAGO, IL 60612-4861
(312) 942-6100
(312) 942-6225
Mailing address
1611 W HARRISON ST, SUITE 550, CHICAGO, IL 60612-4861
(312) 942-6100
(312) 942-6225
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036072375
IL
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
036-072375
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036072375
—
IL
01
—
CB1567
RRMC
IL
Enumeration date
07/19/2005
Last updated
05/04/2011
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