Individual
STANTON NIELSEN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2650 RIDGE AVE STE 1304, EVANSTON, IL 60201-1700
(480) 338-1585
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036.163773
IL
Other
Enumeration date
04/28/2017
Last updated
07/24/2023
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