Individual
NIKOLAS MATA-MACHADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 E 14TH ST APT 801, CHICAGO, IL 60605-3666
(773) 569-1822
Mailing address
100 E 14TH ST APT 1202, CHICAGO, IL 60605-3671
(718) 300-2246
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
036131814
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036131814
—
IL
Enumeration date
06/17/2010
Last updated
06/14/2023
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