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Organization

ASSOCIATES IN HEAD & NECK SURGERY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THOMAS J NIELSEN M.D. (PRESIDENT)
(312) 942-2175
Entity
Organization

Contact information

Practice address
1725 W HARRISON ST, SUITE 938, CHICAGO, IL 60612-3841
(312) 942-2175
(312) 942-2052
Mailing address
PO BOX 9, MATTESON, IL 60443-0009
(708) 747-5850
(708) 747-9991

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CB1567
RRMC
IL
Enumeration date
10/24/2005
Last updated
11/25/2009
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