Provider Demographics
NPI:1093732034
Name:MOTT, NICOLE R (DO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:MOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:ZENDEJAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:885 ROOSEVELT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6141
Mailing Address - Country:US
Mailing Address - Phone:630-384-6200
Mailing Address - Fax:630-384-6229
Practice Address - Street 1:17495 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7581
Practice Address - Country:US
Practice Address - Phone:708-364-3163
Practice Address - Fax:708-226-1969
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36112820207P00000X
IL036112820207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine