Individual
NICHOLAS JOHN WAKIM II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5454 HOHMAN AVE, HAMMOND, IN 46320-1931
(219) 932-2300
Mailing address
6333 S COUNTY LINE RD, BURR RIDGE, IL 60527-4866
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02004619A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02004619A
IN STATE LICENSE
IN
01
—
02004619B
IN CSR
IN
05
—
201289430
—
IN
Enumeration date
02/28/2011
Last updated
06/30/2015
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