Individual
MARIAM NIKOLAISHVILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
355 RIDGE AVE, EVANSTON, IL 60202-3328
(773) 273-5927
Mailing address
835 SEWARD ST APT K1, EVANSTON, IL 60202-2837
(773) 273-5927
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
125.083820
IL
Other
Enumeration date
07/29/2024
Last updated
07/30/2024
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