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Individual

DR. JOHN NICKLESS JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1611 W. HARRISON ST., CHICAGO, IL 60612
(312) 243-4244
Mailing address
1611 W HARRISON ST, CHICAGO, IL 60612-4861
(312) 243-4244

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125.063116
IL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
036.139134
IL

Other

Enumeration date
06/16/2013
Last updated
07/22/2016
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