Provider Demographics
NPI:1164441051
Name:WILLIAMS, NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WILLIAMS
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 1:1147 S WABASH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2346
Mailing Address - Country:US
Mailing Address - Phone:312-929-9191
Mailing Address - Fax:312-566-8986
Practice Address - Street 1:1147 S WABASH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2346
Practice Address - Country:US
Practice Address - Phone:312-929-9191
Practice Address - Fax:312-566-8986
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116334207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBS OF IL
IL1235573197OtherCORPORATE NPI
IL1235573197OtherCORPORATE NPI