Individual
NICHELL TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(800) 543-7362
Mailing address
225 E CHICAGO AVE # 152, CHICAGO, IL 60611-2991
(800) 543-7362
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036086376
IL
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
036086376
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086376
—
IL
Enumeration date
07/20/2006
Last updated
04/29/2020
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