Individual
NICHOLAS R IDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
611 W. PARK ST., HVI, URBANA, IL 61801-2500
(217) 904-7000
(217) 904-7742
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004157
IL
363AS0400X
Surgical Physician Assistant
085.004157
IL
Other
Enumeration date
10/27/2011
Last updated
02/03/2016
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