Provider Demographics
NPI:1114943065
Name:NICHAMIN, HENRY DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:DAVID
Last Name:NICHAMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:705 EAST GOLF ROAD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4511
Mailing Address - Country:US
Mailing Address - Phone:847-843-0200
Mailing Address - Fax:847-843-0281
Practice Address - Street 1:705 EAST GOLF ROAD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4511
Practice Address - Country:US
Practice Address - Phone:847-843-0200
Practice Address - Fax:847-843-0281
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036078464207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10640725OtherCAQH
ILQXIPQ0000184553OtherAETNA BETTER HEALTH
ILBN2405670OtherDEA
IL10640725OtherCAQH
ILE62212Medicare UPIN