Provider Demographics
NPI:1073799235
Name:MACAULAY, NICOLE OLUWABUNMI (MD)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:OLUWABUNMI
Last Name:MACAULAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 CHURCHVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107
Mailing Address - Country:US
Mailing Address - Phone:815-971-2000
Mailing Address - Fax:815-395-2021
Practice Address - Street 1:5970 CHURCHVIEW DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-2574
Practice Address - Country:US
Practice Address - Phone:815-484-6398
Practice Address - Fax:815-395-2021
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000841207V00000X
IL036120392207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology