Provider Demographics
NPI:1093345340
Name:PAUL, NICOLE JADUE (MD, MS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JADUE
Last Name:PAUL
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:CECILIA
Other - Last Name:JADUE GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MS
Mailing Address - Street 1:1500 S. CALIFORNIA
Mailing Address - Street 2:#F1008
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608
Mailing Address - Country:US
Mailing Address - Phone:773-257-6025
Mailing Address - Fax:773-257-6045
Practice Address - Street 1:1500 S. CALIFORNIA AVE
Practice Address - Street 2:#F1008
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:773-257-6025
Practice Address - Fax:773-257-6045
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125075968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine