Individual
KYRA NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5841 S MARYLAND AVE # MC6040, CHICAGO, IL 60637-1443
(773) 702-1000
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
125.074986
IL
Other
Enumeration date
06/26/2019
Last updated
07/16/2019
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