Individual
NICOLE BONIQUIT LEVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2450 WOLF RD, STE F, WESTCHESTER, IL 60154-5643
(708) 236-2673
Mailing address
1 WESTBROOK CORPORATE CTR, STE 240, WESTCHESTER, IL 60154-5701
(708) 236-2600
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
125061401
IL
2080S0010X
Pediatric Sports Medicine Physician
Primary
036141341
IL
Other
Enumeration date
06/17/2012
Last updated
02/25/2019
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